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ACA vs. ObamaCare: What's In a Name?

Posted by John McDonough  January 14, 2012 11:54 AM

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A friend and health policy colleague sent me this email:

I have one minor suggestion for the future. The other day in an interview a reporter asked me if I was a in favor of the new legislation because I kept calling it the Affordable Care Act rather than ObamaCare. I responded that it was the name of the law and that Congress passed the legislation and that the President did not propose a bill. I also noted that we never refer to Medicare as Lyndon Johnson Care. He got the point -- using the name implies something bad and attributes to a single person. I think the media is distorting every time they fail to use the name of the legislation. Thus I go out of my way never to use it. Note that Romney is not saying repeal the Affordable Care Act. Maybe he has something else in mind?

Her words got me thinking, and led me to write this post.

Let's start with what we know. First, the health reform law signed by President Barack Obama on March 23, 2010 is titled the "Patient Protection and Affordable Care Act" (PPACA). One week later, the President signed a follow up law, the "Health Care Education and Reconciliation Act" (HCERA) which made many important changes to the PPACA in order to win support for PPACA in the House of Representatives.

After both laws were signed, it was left to the Legal Counsel Offices of the Senate and House to come up with a single version that merged both laws. (Now there is an intriguing and unwritten health reform story -- and they'll never tell!) That combined version is also identified officially as PPACA.

Some folks in the Obama Administration as well as other supporters felt that PPACA (pronounced "pee-pahka") was too much of a mouthful, and wanted something simpler. PPACA really refers only to the first law, signed on 3/23/10. Often, one needs to refer to that first law as distinct from the version combined with HCERA. Thus, some began using the term, "Affordable Care Act" (ACA), as a short-hand for the combined PPACA/HCERA, and to bring a more easily-remembered acronym into use. Thus, ACA appeared, and became the term used by most of the law's supporters.

Early references to "ObamaCare" began appearing in 2007 and 2008, not to be derogatory, but as shorthand to distinguish it from Hillary Clinton's (Obama's Democratic presidential rival) plan. HillaryCare or ClintonCare were terms first used by opponents of the Clinton health reform proposal in 1993 and 1994, just as "RomneyCare" became shorthand for the 2006 Massachusetts health reform law. It was in the hot "Tea Party" August of 2009, when health reform opponents and proponents confronted each other in Congressional town hall meetings, that "ObamaCare" was first widely embraced by opponents, and they have stuck with the term ever since.

And so, we not only have a sharp partisan divide over the law, we have a sharp partisan divide over what to call it. The divide has only deepened since the law's signing in March 2010. Last fall, House Democrats tried to use House rules to keep their Republicans colleagues from referring to "ObamaCare" in legislation and in official mailings. Cong. Debbie Wasserman Schultz, Chairwoman of the Democratic National Committee, has called the term "disparaging" to the President.

One wonders how many Americans even know that the Affordable Care Act and ObamaCare are one and the same thing. Now there's a question for the Kaiser Family Foundation's monthly health tracking poll.

President Obama tried to soften the word fracas at an event last August, saying: "I have no problem with people saying Obama cares. ... I do care," he pointed out. "If the other side wants to be the folks who don't care. That's fine with me."

Screen-shot-2011-06-08-at-8.26.45-AM.pngMichigan Congressman John Conyers (above) weighed in last June to The Hill: "I like the term ... I wish I had invented it myself. ... The fact that a healthcare bill is named after a first-term president who does what two other presidents before him couldn't accomplish is really a compliment. ... A few years from now, ObamaCare will be looked upon as a complimentary description, rather than what [critics] are trying to portray it as now."

Still, there is my colleague's concern, expressed in the email at the top of this post "...using the name implies something bad."  I can't think of another law the name of which has been subjected to such controversy. "Reaganomics" perhaps, though that was a term to describe overall economic policy, not a single statute. And there is an undeniable strategic advantage "ObamaCare" gives to the law's opponents. Calling it "ObamaCare" makes one's views of the law a mini-referendum on President Obama. If Obama's favorables were in the 60% range, it might not be so bad. But in the mid-40s, it sets an artificial ceiling making people more likely to judge the law unfavorably because they don't like the President.  Thus, the nation's partisan divide contributes to negative feelings about the ACA as well.

This was affirmed in the November 2011 Kaiser health tracking poll which found that fully 44% of those who view the ACA unfavorably say their feelings are "more about my general feelings about the direction of the country and what's going on in Washington right now." So ACA supporters pay a price for losing the naming war over the nation's health reform law. This reflects the weakest part of the ACA implementation effort -- the unsuccessful effort to communicate the law's positive features and impact to the American public.

So what's a conscientious blogger supposed to do?

I will continue to straddle this fence. Like it or not, most Americans know this law as "ObamaCare" and not as the "ACA." I refer to it as the ACA when it makes sense, usually when discussing policy. When it makes sense to me, I use the term "ObamaCare," especially when discussing politics, though I always try to pair it with ACA.

As I teach all my students, politics is the way people decide who gets what, when, where, how, and why. This naming dispute is a first-rate example of the politics of naming. Who gets to name the nation's health reform law? Right now, the opposition rules -- though my heart is with Obama and John Conyers on this.

Opponents may come to rue the day they embraced ObamaCare!

This blog is not written or edited by Boston.com or the Boston Globe.
The author is solely responsible for the content.

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About the author

John E. McDonough is a professor of practice at the Harvard School of Public Health. He is the author of the book “Inside National Health Reform”, published in 2011 by More »

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