Skip to Main Content

WASHINGTON — The Obama administration is trying once again to address a criticism that has dogged the president ever since his health care bill passed six years ago: they need to sell it better.

And this time, they’re paying a lot more attention to the medical side — the parts that no one outside of a narrow circle of health care wonks really understands.

Until now, much of the debate has raged around the health insurance side. The administration is betting many people still don’t fully understand the law or how it’s trying to improve the actual medical care they receive — like making sure doctors talk to each other, or getting hospitals to do a better job so patients don’t have to come back right after they’ve been released.


So now they’re turning to the next phase of their sales pitch for the law: touting the reforms to American health care that might be subtler than expanded insurance coverage, but affect far more people.

On Tuesday, the US Department of Health and Human Services is rolling out a new promotional video, which was provided to STAT first, to explain the changes the administration is making to the health care delivery system through the law.


It’s a three-minute, rapid-fire, visually driven attempt to make terms like “care coordination” and “electronic health records” something that an average person who is getting his or her knee operated on can actually understand.

Or “delivery system reform,” for that matter — the broad, but wonky, term that describes all of the attempts to improve the way people get their medical care.

“Part of the problem is that people get frustrated and they know that something isn’t working right, but they can’t necessarily pinpoint as a patient what isn’t working right,” Dr. Meena Seshamani, director of the HHS Office of Health Reform, said in a phone interview. “We’re dealing with very wonky subjects and ideas on a system level that you need to translate to what this actually means when the person actually goes in to get care.”

The video, released the week of the law’s sixth anniversary, is part of a broader campaign the administration is undertaking to explain what the law is doing to try to improve health care delivery. A series of events will be held at the White House starting in April that will focus in part on the same subject, according to HHS officials.

Selling the health care law, called the Affordable Care Act, has been a recurring challenge for the Obama White House ever since its contentious passage in 2010. Its approval ratings have been mired in the low-40 percent range for years, according to the Kaiser Family Foundation, and most of the time, more people have disapproved than approved of it.

Furthermore, more than half of Americans don’t think the law has affected them at all, according to Kaiser, and those who do are more likely to say it’s hurt than helped them. Its most well-known provision? The loathed individual mandate — the part that requires nearly all Americans to get health insurance.

“The ACA is a huge piece of legislation with many tentacles. It’s not a simple, identifiable program like Social Security or Medicare, which makes it hard for people to understand and hard to build loyalty and support,” Larry Levitt, a senior vice president at the Kaiser Family Foundation, said in an email. “Many people who have benefited from the ACA don’t even necessarily know it.”

Administration officials know that’s the barrier they have to overcome.

And the challenge now is to explain not just the health insurance changes that might help some people in a clear way — like when they hit their new annual out-of-pocket spending cap and don’t have to pay another dollar for their care the rest of the year — but the less concrete world of changes to the way doctors and hospitals provide their medical care.

“One of the interesting parts about delivery system reform is that this has the potential to impact a much broader section of people,” said Kevin Griffis, HHS assistant secretary for public affairs.

But it’s also harder to make it “real” to people. The law’s most obvious metric for success is the 20 million people covered by its insurance expansion, but far more people have been frustrated because their knee surgeon isn’t sharing information with their primary care doctor, or they had a loved one readmitted to the hospital because their care wasn’t quite right the first time.

HHS is trying to address those issues with programs started under the ACA aimed at reducing hospital readmissions, preventing life-threatening injuries after people arrive at the hospital, and encouraging providers to coordinate for complex procedures like knee replacements.

Wider and better use of electronic health records is another focal point for the administration as it winds down.

Those are the programs that fall under the “delivery service reform” umbrella that HHS is trying to promote.

“I think at the end of the day, people understand something when it affects them or someone they know,” Seshamani said.

So why is the administration only getting to this with less than a year left in President Obama’s tenure? Well, first, it had to get the insurance expansion part right, HHS officials said. And that wasn’t easy, to put it mildly.

It looks like a solid success now, with 20 million covered by the law, but the optics were messy in the early stages. The 2013 debut of, the federal insurance marketplace, was a public relations disaster, and Republicans frequently muddled the issue by arguing that millions of people were losing their coverage, even if others were gaining it, and alleging the law caused skyrocketing insurance premiums.

“The meaningfulness of a conversation about delivery system reform, it just would not have the same impact if we have 50 million people who lack insurance,” said Griffis. “We needed to focus for the first years of the law on the access portion of it.”

The Obama administration also said they had to wait until they had tangible results to show for initiatives like the hospital readmission program. Now, the administration says it has prevented 565,000 readmissions between April 2010 and May 2015. A study by HHS researchers bases that estimate on a lower rate of readmissions for the specific conditions targeted by the program.

Even with this focus, the messaging isn’t a slam-dunk for the administration. Some doctors and hospitals — the people who interact with patients — have been critical of the programs that HHS now wants to promote to the public.

But HHS officials say they have broad support from the industry for these programs. They cite the involvement of 5,000 people, including health care providers, in an outreach group focused on moving toward quality instead of quantity in health care payments.

“Sure, there are going to be disagreements over details,” Seshamani said, “but people know this is where we need to head.”