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“As you may know, a health reform bill was signed into law in 2010. Given what you know about the health reform law, do you have a generally favorable or generally unfavorable opinion of it?” (Kaiser Family Foundation tracking poll question)

The Affordable Care Act was signed into law in 2010. Most of its controversial provisions were delayed for 2-4 years, partly to allow the taxes to pay for the subsidies to ramp up and partly, I suspect, to put some distance between the passage of the law and the reelection of the lawmakers. The distance aspect was not nearly as successful as it could have been, as many folks developed a deep and persistent hatred for the law. Kaiser Family Foundation, a non-partisan group focused on health care access, has tracked public opinion since the law was signed. In April 2010, 46% of Americans viewed the law favorably, 42% unfavorably and 14% had no opinion. In March 2015, favorables have gone down to 41% and unfavorables have stayed roughly the same. In other words, opinion has not changed much in the past 5 years.

Part of the reason that people are ambivalent is that until they approach mid-life, their interactions with the health care system are limited. Half of all Americans spend less than $300 annually on health care. Basically, some folks may have noticed that their contraceptive method was a little cheaper (thanks, Obama) and some may have noticed a higher co-pay for their once a year visit for allergy symptoms (thanks A LOT, Obama). Once people hit 65, they are in the Medicare system. This system is being affected by changes in care delivery but not in a way noticeable to the average consumer. Even so, 46% of those over 65 view the law in an unfavorable light. (What, Medicare doesn’t pay for Viagra? THANKS FOR NOTHING, Obama).

Many changes in health care were put into motion prior to the passage of the ACA. These include efforts to improve Medicare quality (Bush), improved access through better funded community health centers (Clinton, Bush) and money for better health care information technology (Obama). With the ramp up to ObamaCare being several years, almost anything that folks notice that is different from when they previously sought care (What, no cough syrup for babies anymore? Damn you Obama!!!) is blamed on Obama.

This brings me to the story of my friend, John Waits. He is a rural family physician who lives in Centreville, Alabama. He has a wife, several (I believe 5) children, and a passion for rural medicine and for his adopted home town. I have known John for about 10 years, and he has consistently wanted to bring training to rural Alabama. Through a combination of a Bush administration program designed to improve access for the poor (expansion of community health centers) and a program included in the ACA designed to take money away from large hospitals and move it into communities where it can do the most good (Teaching Health Centers) he was able to do just that. Although the funding was through the ACA, the idea, like many included in the law, was much older and was a bipartisan idea.

The funding for the teaching health center side needs to be renewed, and so John has been speaking out a bit. Not calling attention to our lack of Medicaid expansion. Not calling attention to the fact that we only have one statewide insurer so no real competition. Simply asking our delegation to pull the Teaching Health Center idea from the ACA and make it a separate idea to allow him to continue to train doctors for rural Alabama, in rural Alabama. Al.com posted a nice story about it.

Someone forwarded me the story, so I sent John a congratulatory email: subject line, IGNORE THE COMMENTS. There are now 230 comments on the article at al.com. The commenters are projecting what they believe about the ACA onto poor John’s program, including at least one former patient who will not see him OR ANY DOCTOR whose boss is the “gummint.”

The lesson for all of us, I suppose, is to be like John and keep on trying to do the right thing. Read more about Teaching Health Centers (here is a place to start). Call your representative and ask for the Teaching Health Center program to be continued (it is currenty in the SGR repeal bill stalled in the Senate). Mostly, be like John and do the right thing even at some personal cost. And always: ignore the comments.

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