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Kaiser and the Affordable Care Act

Drew E. Altman, Ph.D., President and Chief Executive Officer. Updated: August 2014

Many of you have commented over the years on my President’s Message on this website which explains our purpose and mission in creating the modern day Kaiser Family Foundation and how we operate. I update it periodically to keep it current as we evolve. With the passage, implementation and continuing debate about the Affordable Care Act, I thought I would provide a companion essay about our role on the ACA.

Our mission, stated at the top of our home page, is “filling the need for trusted information on national health issues.” It is inspired by our benefactor Henry Kaiser’s motto: “find a need and fill it.” Henry Kaiser was talking about finding a niche in American industry, but that is also what we try to do in a different time and in the very different world of health policy.

Our mission doesn’t change because of the passage of the ACA or the hyper-partisan environment in which it is being implemented. We have addressed all kinds of health policy legislation over the years, dating back to the Clinton reform effort which unfolded just as we were creating the modern day KFF, and we are accustomed to operating in a highly politicized health policy environment. In fact, when it comes to politicized health policy issues, I can remember earlier election-driven Medicare debates that would give the current ACA discussion a run for its money.

As in these past debates, our role on the ACA is to inform the debate and give the American people information they can use to understand the law and make the best choices for themselves and their families. We do this through the facts and analysis we produce; our polling and survey research; our news service (Kaiser Health News) and our many other efforts to help strengthen news coverage; and through the events we hold and our daily role in the field as explainers and technical experts. Certainly we want to see more Americans have insurance coverage and better protection from the sometimes crushing burden of health care costs. But at Kaiser we take no position on the ACA, or any other law or proposal for that matter. Some laws are good, some bad, and most are a mix of good and less good. Some are popular and some less so. Our role is the same whether we are working on Medicaid, Medicare, the ACA, or any other law or health policy issue.

One difference now is that the ACA is a law that has actually passed and is being implemented. But it is a difference mainly of scale and complexity. We have worked to inform the implementation of other laws in the past, such as CHIP and the Medicare drug benefit, and we have long specialized in Medicaid which like the ACA involves a big role for the states.

With this in mind, we have a five-part strategy for our work on the ACA:

1. PRODUCING FACTS AND ANALYSIS. This is the backbone of what we do. The key to our work, on the ACA or any issue, is picking the right topics to work on so that we are useful and relevant, getting the timing of what we do right, and getting information to our core audiences in understandable and digestible forms, especially policymakers and the media. Many of us have PhDs and have been in academia, but our business is different from the academic enterprise. We do not start with what the unanswered or interesting research questions are, we start with what information is needed by policymakers, the media and the public to inform policy debates. Occasionally we are called a “think tank.” I like to believe we think, but we function differently from most think tanks. We operate large programs such as a national news service, an in-house polling operation and large national media campaigns such as Greater Than AIDS. Another difference from most think tanks is that everything we put out is an organizational product, not the work of individual scholars, authors or opinion leaders.

2. INFORMING JOURNALISTS AND NEWS ORGANIZATIONS. We have always placed equal weight on policy analysis and media at Kaiser, and the ACA is no exception. With Washington and the Congress in a hyper-partisan boil, the news media play an even more important role than at any time since we established the modern day KFF at mediating national policy debates and informing the public. One of our biggest and most resource-intensive commitments as an organization is to be an everyday resource for journalists and news organizations as they cover the ACA. Our goal is not to be cited or quoted, it is to improve the quality of health policy information the American people get, and we are keenly aware that anything we do directly ourselves to put out information pales in comparison to the reach of the media, in all of its current day forms. We also have long operated fellowship and other programs to help journalists better understand the intricacies of health policy.

3. PRODUCING OUR OWN JOURNALISM. In June of 2009, we established our own news service, Kaiser Health News (KHN), to provide in-depth coverage of health policy, free of the competitive and bottom line pressures that affect most commercial news organizations. KHN is the successor to kaisernetwork.org, which produced daily news summary reports and webcasting but not original journalism. KHN is a regular foundation program but it is editorially-independent, and a fully credentialed national health policy news service. We distribute our KHN content free through a wide range of partners such as The Washington PostUSA Today, and NPR. An important thrust now at KHN is to cover the ACA story as it unfolds in states and communities beyond the Beltway. To that end, we have established a new regional newspaper network and partnerships with many NPR affiliates across the country, and we are expanding our west coast coverage and developing a California bureau. KHN also produces two highly popular daily news summary reports, as well as original programming from our broadcast studio in our D.C. building.  We are also now producing health policy coverage for the NewsHour. You can catch KHN reporters frequently on C-SPAN or the NewsHour explaining health policy developments. As the ACA gradually fades from the headlines there will be an even greater need for KHN.

4. POLLING AND SURVEY RESEARCH. Our monthly tracking polls are among our most prominent products and familiar to many of you. Our polling group designs our polls not just to monitor opinion, but more importantly to examine people’s experiences with the ACA and their level of knowledge about the law. Because we have been polling about health reform since the early 1990s, we have a well-tested battery of questions and a repository of experience that we can bring to polling about the ACA. We always adhere to the highest methodological standards in our polls and maintain sample sizes that allow us to report confidently on relevant subgroups of the population. In addition to the polls we conduct ourselves, we also conduct in-depth special project surveys with news media partners, most notably The Washington Post, with whom we have conducted twenty-seven survey projects, as well as The New York Times. We are also fielding several large-scale special surveys at Kaiser designed to assess the impact of the ACA, with a focus on the lower income and uninsured populations. Many of you are also familiar with our benchmark annual survey of employer health benefits and premiums, which we release every year around September.

5. CONSUMER INFORMATION. With ACA implementation moving forward and our polls showing that so many people are uninformed or confused about what the law means for them, we are ramping up our consumer information materials. We have made a solid start with our ACA Calculator, our animation narrated by our Trustee Charlie Gibson, our FAQs, and our quizzes. But, we plan to do much more, including translating much of our consumer information into Spanish. Our goal in doing all of this is not to be a direct resource for consumers, since that is generally not our role and we don’t have the means to answer questions from millions of people about their individual circumstances. Rather, we will distribute what we produce through media partners and direct people to local resources that will help them make individual choices. The more time I spend talking about the ACA, the more I am convinced of the need for basic information about what the law does and does not do. Overall this has been one of our greatest discoveries at Kaiser about health policy information: basic facts and explanations are as powerful in our world as the seminal study. We try to do both and everything in between.

These roles and strategies – facts and analysis, assisting news media coverage, our own news service, polling and survey research, and consumer information – are the main tools we use to take on ACA implementation. Every day, in each of these areas, we make decisions about what analyses we want to do, what polls and surveys to do next, what news stories we do at KHN, what events to hold, what media appearances to accept or decline, how many journalists and news organizations we can assist that day, and so forth. For an operating organization, all these choices require resource commitments. Many organizations make these kinds of decisions. These tactical decisions translate the strategy into impact. There is no manual for making them; they are the art of what we do and hopefully we mostly make the right calls.

Lastly, across all of the elements of Kaiser’s ACA strategy, we maintain a consistent focus on the issues and developments that most affect people, and especially people with the greatest health and economic needs. The focus on people is the hallmark of our organization. Others will focus on health professionals and health care institutions or the health care industry, all important issues as well. But, with some exceptions, that is not what we emphasize. We put information to work for people and try to focus on the policy issues and choices that affect millions. The choices we make about what we choose to do and choose not to do with our limited staff and financial resources are always guided by this compass.