What's the real deadline for Obamacare?
Don’t be distracted by the heightened interest that surrounded October 1 – the “go live” moment for Covered California, the health insurance exchange born of the Affordable Care Act.
In truth, neither October 1, nor even January 1, 2014, when the coverage itself begins for new enrollees, looks to be the defining day for Obamacare, as the act is popularly known. A better target may be 13 months from now -- Tuesday, November 4, 2014, otherwise known as midterm elections day.
Despite the fact that more than three years have passed since the passage of the Affordable Care Act; despite the fact that the law was constitutionally blessed by the United States Supreme Court in a decision announced on June 28, 2012; and despite the fact that several provisions of the law have already taken hold, public polls indicate there is ongoing, significant opposition to the law, and many Republican lawmakers continue their attempts to stall, limit and overturn it.
Were Republicans to show significant gains in the midterm congressional elections, which often favor the party out of power, the law’s future might continue to be in jeopardy.
For now, in California, there are more immediate concerns. California was the first state to begin implementing the act, passing legislation in 2010 to create an exchange. Since then, state agencies, aided by hundreds of millions of dollars in federal assistance, have been in high gear to ready the exchange for business.
While exchanges begin operation around the nation, California officials are well aware that their state is seen as the spear-carrier for Obamacare. If the process goes right here, the thinking goes, it can surely work elsewhere, in smaller, less complex, more manageable states. If it goes right, who would dare suggest overturning it? But if things go wrong, experts say, California becomes a harbinger for national failure that will embolden critics and provide kindling for November 2014.
Things can start to go right or wrong in at least four areas:
1. Outreach. Will people know enough about the exchange to participate in it? Will they want to? The state has poured millions of dollars into its outreach scheme, but no one is sure how successful it will be. Potential glitches may develop between state-sanctioned outreach groups, who are used to working with low-income clients, and the working and middle class populations they’ve been charged to engage. Embedded in the outreach strategy is another critical question: Can these groups engage Latinos and the so-called Young Invincibles – those between 18 and 34 who think they either don’t need insurance or can’t afford it? There’s consensus among experts that the success of Obamacare in California hinges on informing, then signing up, significant numbers in these two, sometimes overlapping, constituencies.
2. Sign-up. If the Covered California site is primed for action, online sign-up may work for some or many. Still, many others may need special help understanding and comparing coverage options and working their way through the signup process. The exchange says it stands ready to assist with trained enrollment counselors. But the proof lies in the process experience and its results.
3. Access. Even if Covered California is successful in signing up eligible residents, the real test comes when these new policyholders try to see a doctor. With no new source of health care professionals in the pipeline, will there be sufficient providers? And will the newly insured be seen in a timely manner?
4. Cost. There’s reason to believe that even with subsidies, the cost of some plans will make it a difficult choice for many individuals and families. A $95 fine and no insurance coverage might be the only alternative for those who, even after government help, cannot afford $100 per month in premiums.
Without question, there have already been victories in the ACA rollout. Already, parents can keep kids on their policies until they are 26. On January 1, when the law kicks in, no one can be denied insurance for a pre-existing condition like cancer or diabetes or heart disease. And older residents, despite statistics showing they use the health care system substantially more than younger people, can’t be charged more than three times the lowest rate for their insurance premiums. These are victories people will want to hold on to, no matter what.
Still, given the evident anxieties Americans continue to voice about the new law, managing perceptions is a primary task of officials hoping to orchestrate a successful birth. Peter Lee, who heads the Covered California effort, only half-jokingly told reporters recently that he expected two people to sign up on the opening day of the exchange, and not many more the rest of the first month. Many, he said, will sign up the last two months of this year. He also has said that his goal is to sign up at least 500,000 through the exchange by the March 31, 2014 deadline.
Yet a poll taken only a month ago by the Kaiser Family Foundation found that a majority of those uninsured who are eligible for the exchange felt they had inadequate information about its process and benefits.
Will they sign up?
At a health journalists’ conference last spring, one of the architects of the ACA warned that it was going to be heavy seas during the early going of its implementation. He said he had no doubt that journalists would write about all the problems of the rollout, but he had high hopes that problems would be addressed and resolved a year into the new law.
Well, that year is about to begin. And no matter anyone’s stance on the merits of Obamacare, the country will be forced to wait, anxiously, while the new health care policy landscape takes shape. That is when a final verdict on the law will likely come. And that will not be October 1 or January 1, but on November 4, 2014.