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Judy’s Notebook: Three Years Later, Still in the Dark on the Affordable Care Act

We’ve moved on to other news stories since then: the Deepwater Horizon oil spill in the Gulf, the shooting of former Congresswoman Gabrielle Giffords, the Arab Spring, the killing of Osama Bin Laden and the 2012 presidential campaign, for starters.

But the health care reform law signed by President Obama in March 2010 will have arguably a bigger impact on the lives of more individual Americans than any of these. And a new survey demonstrates that a disturbingly large number of them still don’t understand it — or the impact it will have on them.

The Kaiser Family Health Foundation reported Wednesday that the public remains “uninformed and divided” about the law, based on a survey conducted earlier this month. Fifty-seven percent of those polled said they didn’t understand Obamacare well enough to predict how it would change their own health care. More alarming, among those without health insurance and those who earn less than $40,000 a year — the very pool of individuals the law was mainly designed to help — two-thirds said they didn’t have enough information.

In other words, after three years of efforts by the Obama administration to explain the law to the American people, including targeted messages to the uninsured and those with lower incomes, many are just as in the dark as they were during the political debate that seemed to go on forever. In fact, the Kaiser survey shows that public awareness and understanding of some of the most important elements of the law, such as the availability of health insurance tax credits for individuals and small businesses, has actually declined since the law went into effect.

Opinion of the law is, less surprisingly, also still divided, and mainly along party affiliation lines, but favorable views have declined just in the past few months. Now, 40 percent of Americans say they have an unfavorable view of health care reform, 37 percent say their view is favorable, and 23 percent either refused to answer or said they didn’t know enough to answer. When Obamacare was signed into law, that was flipped: 46 percent held favorable views, 40 percent unfavorable, and 14 percent said they didn’t know or declined to say.

Sixty-eight percent of Republicans have a negative opinion of the law; 58 percent of Democrats have a positive one. Kaiser says these findings are consistent with what they’ve seen since the law was enacted.

Republican presidential nominee Mitt Romney had pledged to undo health care reform if he were elected, but with his defeat, the law is safe at least for the next four years. That means the Obama administration has its work cut out for itself in the months ahead. What it has going for it is the fact that the public seems to approve of individual features in the law, such as those health insurance tax credits for small businesses, improved prescription drug coverage under Medicare, and expanding Medicaid, as well as requiring insurers to offer coverage to people with pre-existing conditions. But surveys show that many people don’t realize the policies they like are included in the law. The Kaiser poll, for example, revealed that fewer than half of those who responded knew about the law’s provisions that expand the Medicare drug benefit.

And large percentages of Americans still hold the false belief that Obamacare created so-called “death panels” to ration health care for those on Medicare, or provided coverage to undocumented immigrants. A majority hold the erroneous view that the law created a government-run health insurance program — once called the “public option” — to compete with private insurance companies.

President Obama and his team push back regularly on Republican claims that the law will raise health care costs, while physicians seem to be shifting gradually, if begrudgingly, to more positive attitudes about the Affordable Care Act.

But the larger task has to be informing Americans about the tangible changes ahead as the rest of the provisions of the law take full effect. It is hard to think of another piece of sweeping legislation that has required this massive of an education effort so long after it became the law of the land.

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