‘The Spin:’ How the ACA and BCBS Work to Manipulate You

Like many Illinois Blue Cross Blue Shield members who bought their insurance through GetCovered.Illinois.gov last year, I got the notice that my plan would be discontinued . . . and that, in their infinite generosity (*dripping sarcasm* alert), BCBSIL would be automatically enrolling me in a ‘similar plan’ (a ‘Blue Choice Preferred’ plan to be exact).

Trouble is, just like it was when I was working for the Lake County Health Department back in 2013 (when the ACA was first being rolled out), that BCBS is playing particularly well at a game of shells with their “Blue Choice” and “Blue Choice Preferred” PPO plans . . . which are basically HMOs wrapped in distracting terminology.

Even in the insert of ‘IMPORTANT CHANGES TO YOUR PLAN’ sent to me in the notice of my plan change, no where was it mentioned that there would be a drastic change in network size (none of my doctors or hospitals would be accepting this ‘similar’ plan).

Most disturbingly, If I hadn’t worked as an ACA ‘Navigator’ myself, I would never have known these details.

For more information about the “Blue Choice” changes, please read this fabulous article, “Trick (no Treat) from Blue Cross Blue Shield Illinois.”

From the beginning, the ACA was all about ‘the spin.’

In Tolstoy’s Anna Karenina, the villains’ chief defect is their preference for a beautiful facade of social service over a commitment to meaningful action.  Consider this exchange between Prince Oblonsky, a shallow urban civil servant, and Constantine Levin, a country nobleman:

“‘I don’t understand what you are doing,’ said Levin, shrugging his shoulders. ‘How can you do it seriously?’

‘Why not?’

‘Why?  Because there’s nothing in it.’

‘You think so, but we’re overwhelmed with work.’

‘On paper.  But, there, you’ve a gift for it,’ added Levin.

‘That’s to say, you think there’s a lack of something in me?'”

Now, while it wasn’t my first taste of the Get Covered Illinois PR machine, in March I had seen it roll into Waukegan.  Walking from the county parking garage into a day of appointments at the library, I began to catch glimpses of a large, and all-together glaringly orange RV that looked like it would be more at home at (a really lame version of) Woodstock than it was in front of a local library.

Before I went in, I saw a man timidly approaching the bus, aptly named with “the hashtag-included #Road2coverage RV” . . . Because, God knows, you have to draw in those all-important ‘Young Invincibles’ with their social media savvy.

The man, in his curiosity, stood with one foot on the RV’s steps and one foot on the sidewalk — asking the kinds of questions I didn’t even know the answer to after working there for seven months: “What is this?  Who are you guys?”

The first librarian I met inside was equally clueless — “Yeah . . . we don’t know much about it,” — as were the librarians actually tasked with the library’s portion of ACA work — they had been given the ‘special’ privilege of morning-of notice.

Like a significant other that tags along with the friend that you actually did invite to your 30th birthday celebration, the Get Covered Illinois party bus’ raison d’etre was apparently to drive around the state, crashing enrollment sites, and getting a contact high.

And when the RV’s passengers disembarked . . . whoo, Lordy — talk about a well-oiled machine!

I suppose because the people who manned the bus weren’t certified Navigators or even CACs (meaning they couldn’t answer substantive questions or help you fill out your application), they must have had a lot of time on their hands to figure out the best ways to present the various branded materials they carted with them.

Within ten minutes of the first moment their feet hit ground, the children’s area of Waukegan Public Library was transformed into an on-location Get Covered Illinois set . . . complete with an actual director’s chair.

Giovanni Gomez, Gov. Quinn’s glorified secretary, was there for a hot minute — kissing babies and shaking hands — wearing a trench coat he refused to take off while inside for no apparent reason.  As busy as he was, texting and taking calls for the whole twenty minutes he was there, he of course had time to take a photo, in the director’s chair in front of the branded backdrop, with the rest of the ACA-related library staff.

Now, the director’s chair served a purpose other than a backdrop for a Twitter-worthy photo shoot.  As our clients exited the private rooms where we met with them, #Road2Coverage staff grabbed them “for just a minute of (their) time.”

In a whirling dervish, they were sticking “I Got Covered!” stickers on our clients’ sweaters and entreating them to sign a release form before stepping into the “testimonial booth” where they could tell their moving story of how their little lives had been impacted by the great and wonderful ACA.

Never mind that most of our clients were in no sense of the word “covered” by the time they left the library.  Either they had put in an application for Medicaid, and would be waiting four or more months for a response (let alone an approval) or they were about to be sailing through some fairly choppy waters — budgeting for a higher than expected monthly premium.

Sensing that they had sufficiently tapped that stone, all of a sudden the Dream Team was packed up and gone as quickly as they had come — even as they remembered to snap a photo of their signs surrounding the library entrance: a photo they uploaded to the Get Covered Illinois twitter page within minutes.  Mission accomplished.

In December, another caveat was added to the grant requirements, and each agency receiving funding was required to send, at minimum, one “success story” weekly to our marketing agency, Fleishman-Hillard.  A somewhat difficult request when most of your clients are on hold for hours just to pay their first premium and Blue Cross Blue Shield’s new “Blue Choice” PPO (looks and smells like a regular PPO carried with one of the biggest insurance companies in the nation, but has a network more restrictive than most of the HMOs offered) is screwing over your own project’s office assistant, who had turned 26 and chosen the “Blue Choice” plan before the problems surrounding its network had been revealed.

And maybe my discomfort with the slickness of this PR-machine was just my own jealousy towards the kind of people who can exist in such a well-coiffed atmosphere.

I found them at every big event I attended as a representative of Enroll Lake County . . . the perfectly put together women.  And as addicted as I was to manicures in those first few months (I had the money, right?  I needed to look professional.  Practically a business expense!), I was always chipped in one way or another.  My type, both on the inside and out, as my mom always describes it, is “perpetually the woman with runs in her stockings.”

When our new project manager, Terri Olian, joined the project in November, she walked in with a perfect blow-out and shiny new highlights strategically placed throughout her hair — while I was absentmindedly tossing my hair up in a barrette and moving on with my day.

But as much as my personal self-esteem might have played into my perception of the ACA’s PR steamrolling, I know that what I truly believe, naive though it may be, is that the public isn’t stupid and that you don’t have to sell them anything they actually want.

I know, you’re thinking, ‘Even Charmin has to enlist those oddly-primary-colored cartoon bears to sell toilet paper — a product everyone wants, and definitely needs.’

‘So,’ you maintain, ‘if you’re intentionally marketing a good product, all you’re really doing is getting the word out — essentially, an educational campaign akin to slapping the food pyramid on the back of every box of Cocoa Puffs.’

But, that simply wasn’t the case here.  When the state is releasing “talking points” on how to pacify those whose job-based premiums have risen or whose coverage has been cancelled altogether and when one of the online training modules cites How to Win Friends and Influence People as a legitimate source . . . that’s when your program has a problem of content — a problem buried deep in its heart: inseparably entwined with its merits.


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