The ads ran just over 100 times during the recent six-month enrollment period. But three conservative groups ran 12 times as many, to oppose the law and the local Democratic congressman who voted for it.
This is a disparity with consequences. Health professionals, state officials, social workers, insurance agents and others trying to make the law work for uninsured Americans say the partisan divisions and attack ads have depressed participation in some places. They say the law has been stigmatized for many who could benefit from it, especially in conservative states like West Virginia that have the poorest, most medically underserved populations but where President Obama and his signature initiative are hugely unpopular.
Steven L. Shattls, chief executive of Valley Health, a network of 28 health centers, said his organization would like to rerun its ad before November, when enrollment resumes. But he also conceded, “We have limited resources.”
Republican candidates and the so-called super PACs supporting them have made assailing the Affordable Care Act their No. 1 issue for the midterm elections, and they are focusing their attacks in states with the most competitive Senate and House campaigns. In few places is that as evident as here in southern West Virginia, where Representative Nick J. Rahall II, a 19-term Democrat, is threatened as never before.
“We don’t know what’s going to happen once they pull out all the stops to trash Obamacare,” Mr. Shattls said. “We’re nonpartisan here. We’re just doing what we’re funded to do, and that is to provide access” to health care.
In the past week, 22 new television ads against the health care law and for Republican federal candidates ran in 14 states. Since last spring, 76 percent of the more than 38,000 Republican-sponsored television ads nationally, and 79 percent in West Virginia, have attacked the law, according to Kantar Media/CMAG, which tracks political advertising.
“Unless public opinion breaks decidedly in favor of the law or some other unexpected but powerful issue arises, Obamacare will remain the top issue in Republican House and Senate TV advertising for the duration of the cycle,” said Elizabeth Wilner, senior vice president at Kantar Media.
While the evidence that such ads, and the partisan climate generally, have hindered sign-ups consists mainly of anecdotes, nearly everyone interviewed in West Virginia volunteered some.
“The controversy about Obamacare does seem to have interfered with people’s ability to sort out the value of the marketplace for getting health insurance for themselves,” said Dr. James B. Becker, associate professor of the Marshall University School of Medicine and medical director of the state’s Medicaid program.
Other problems stymied the introduction of the law, notably the initially dysfunctional federal website. But the political polarization “complicates our efforts to enroll people and to educate people about the Affordable Care Act, there’s no question,” said Perry Bryant, head of the advocacy group West Virginians for Affordable Health Care, based in Charleston, the capital.
“Literally, people thought there would be chips embedded in their bodies if they signed up for Obamacare,” Mr. Bryant said.
Far to the east, at a branch of the Shenandoah Valley Medical System in Martinsburg, Sara R. Koontz, a social worker, said she had heard people express fears about chip implants as well as “death panels” as she sought to enroll uninsured residents. Some told her that they would rather pay a penalty than sign up for insurance, she said, and even people who did enroll paused in their excitement to ask, “Wait — this isn’t that Obamacare, is it?”
Stoking such sentiments in order to rouse conservatives to vote is central to Republicans’ hopes of not only keeping their House majority but perhaps recapturing the Senate. They are counting on West Virginia to help.
In the race to replace longtime Senator Jay Rockefeller, a Democrat and advocate of the health care law who is retiring, Representative Shelley Moore Capito, a Republican, is favored over the Democrat, Natalie E. Tennant, West Virginia’s secretary of state. On her website, Ms. Capito solicits voters’ stories about the “disastrous” law, while Ms. Tennant, echoing the mixed messages of many Democrats, acknowledges the law’s problems but praises its benefits for women and children.
The more closely watched contest is the House race here in the state’s southernmost, poorest district. Mr. Rahall is under attack both from Evan Jenkins, a state senator, and from the pro-Republican groups advertising on Mr. Jenkins’s behalf.
Until recently, Mr. Jenkins was a Democrat, a member of Valley Health’s board and executive director of the West Virginia State Medical Association, which has supported the Affordable Care Act. Now, as a Republican, he backs its repeal.
“Evan knows Obamacare is a mess,” said an ad from the U.S. Chamber of Commerce, which blamed the law for lost jobs, dropped coverage and high premiums. An ad from the group Americans for Prosperity, backed by the conservative billionaires David H. and Charles G. Koch, denounced Mr. Rahall for supporting the law, saying it was “going to hurt a lot of people.”
Many professionals here dispute such claims. “It’s working, and you can show it’s working,” Dr. Becker said.
He and other health care advocates call West Virginia a national success story in terms of the Affordable Care Act’s expansion of Medicaid to more of the working poor. While 24 states have refused to expand Medicaid to those earning up to 138 percent of the federal poverty level, or $23,850 for a family of four, Gov. Earl Ray Tomblin, a Democrat, decided over Republican objections that the state — with a population older and sicker than the national average — would do so.
Nationwide, more people have signed up for private plans than for Medicaid, but the results are the opposite in West Virginia, where about 15 percent of residents — 270,000 of 1.8 million — lacked insurance when the law took effect. Initial sign-ups for Medicaid, about 115,000 since Oct. 1, are nearly double what actuaries projected, and roughly five times the number of people believed to have bought private plans from the one insurer in West Virginia’s marketplace, Highmark Blue Cross Blue Shield. An estimated 20,000 to 25,000 people enrolled in private coverage, fewer than predicted.
State, industry and consumer representatives generally agree on why West Virginia was so successful with Medicaid yet fell short in the private marketplace.
Much of it has to do with the process of reaching out to the uninsured. For Medicaid, state agencies coordinated to write to 114,000 people already receiving nutrition assistance, to seek their authorization for the state to determine whether they qualified for the expanded health benefits. The state followed up with another letter and phone calls. No such outreach was possible to pitch private insurance to people not on public-benefit rolls, and the governor — concerned, insiders say, about being too closely identified with the health care law — turned down federal aid for a marketing campaign.
Many of the uninsured were also deterred from participating by cultural factors: unfamiliarity with insurance, computer illiteracy, Appalachian isolation and, most of all, cost. But also at play was hostility to Mr. Obama.
“The president is definitely unpopular here,” said Jeremiah Samples, assistant to the secretary at the State Department of Health and Human Resources. “I would not discount it as a factor; I have heard folks discuss it.” He added, “There is perhaps a lot attributed to the A.C.A. that is not actuarially accurate.”
“I worry,” Mr. Samples said, “about people not understanding what their options are.”
Original Article
Source: nytimes.com/
Author: JACKIE CALMES
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