As Obamacare exchanges open for business, computer glitches and political opposition will put this sweeping 2010 health care law through its paces. Will Americans embrace these new insurance markets or oppose them altogether?
President Barack Obama and Health and Human Services Secretary Kathleen Sebelius are taking urgent steps to regain ground.
Website Issues
One month since Obamacare went live, problems still abound with its website and enrollment for new health insurance marketplaces slated to open this weekend. Computer glitches, complex federal websites and other issues have delayed enrollment in health insurance markets that were set to open this weekend.
Obamacare opponents have frequently attacked the White House for over-promising how the law would roll out, as well as for allowing its technology contractors to conceal issues behind a veil of secrecy. At the same time, these critics also feel Congress should hold tech officials accountable.
On Capitol Hill, Republicans are hosting hearings this week to investigate why government tech experts were not more open with regard to issues with Obamacare websites, while some congressional investigators have sent letters out requesting documents withheld from congressional staffers by certain contractors.
Subsidies
As insurance cancellations ramped up, unexpectedly the partisan politics of Obamacare emerged in an unexpected form: state resistance to accepting federal grants for health exchanges. At first many states took advantage of these grants to establish exchanges that enjoyed wide public support; but soon political backlash against ACA led many of them to withdraw those grants and cease creating exchanges altogether (Luca, Corlette and Williams 2014).
At a congressional hearing, lawmakers grilled Sebelius over cancellations; most instead focused on possible increases to premiums as a result of Obamacare reform changes in 2022. Responding to criticism, Sebelius pointed to how millions are set to benefit from exchanges this year thanks to legislation passed under the American Rescue Plan and Inflation Reduction Act that enhanced premium subsidies until 2025 – these subsidies cover most of the costs associated with enrolling in plans eligible for subsidies on exchanges.
Taxes
Obamacare relies on healthy young people registering and paying into the exchanges to subsidize the cost of health insurance premiums; that is why its disappointing roll-out was such a disappointment to supporters of the president’s signature reform.
Even after website and other glitches have been addressed, millions of Americans still face an impossible choice: either spending thousands annually on health insurance with high deductibles that they probably won’t use or facing fines when filing their taxes in 2014 for not having coverage.
A less polarized political climate would allow lawmakers to address some of these problems more swiftly; but due to the ongoing partisan battle surrounding the Affordable Care Act (ACA), reform is impossible and even implementation issues cannot be properly addressed. Polarization also facilitates misinformation and sensationalism about its implementation (like death panel myth) to permeate widely without significant correction or refutation (Nyhan 2010). Therefore, until political conditions improve significantly, sensible reform will have to wait.
Coverage Options
Though the Affordable Care Act (ACA) has covered more Americans than ever before, a RAND study estimates that 19 million remain ineligible for Medicaid or subsidies under this system and will therefore be “left behind”.
The Affordable Care Act created online insurance marketplaces (or exchanges), which became operational starting October 1, 2013. These exchanges offer pre-set bronze, silver, gold and platinum plans with differing costs and coverage levels; those with lower incomes may qualify for cost-sharing reductions that reduce out-of-pocket expenses; premiums still don’t come cheap but are more manageable compared to what was available before Obamacare.
The Affordable Care Act also permits states to establish basic health plans with essential benefits, offering assistance for those unable to afford the higher premiums offered through exchanges. Some basic plans are currently available while others will become available during open enrollment periods in 2017. You can also sign up for short-term health insurance that only provides limited protection from medical bills but doesn’t include preventive or maternity coverage.
