Starting yesterday, millions of Americans will be able to shop on the insurance marketplaces that are at the heart of US President Barack Obama’s healthcare reforms, entering a world that is meant to simplify the mysteries of health coverage, but could end up making it even more confusing, at least initially.
Whether consumers will be pleased with the experience, the premiums and the out-of-pocket costs of the plans offered to them will finally start to become clear. Yesterday’s rollout comes after months of buildup in which the marketplaces — also known as exchanges — have been both praised and vilified.
Illustrating the heated political disagreements over the law, the opening of the exchanges comes on the same day as the shutdown of the federal government, led by Republicans in the US Congress who want to block the health reforms.
The shutdown will have no immediate effect on the insurance marketplaces, because they operate with money that is not subject to the annual budget wrangling.
The marketplaces opening in all 50 states are a turning point in US healthcare, the biggest expansion of coverage in nearly 50 years.
The Obama administration hopes to sign up 7 million people during the first year and has a goal of eventually signing up at least half of the nearly 50 million uninsured Americans through an expansion of Medicaid, the government-funded program that provides healthcare coverage for poorer Americans, or government-subsidized plans provided by private insurers.
Yet if people get frustrated with predicted glitches in the computer-based enrollment process and turn away from the program, the prospects for Obama’s signature domestic policy achievement could dim.
“The promise of the law is that no one will go bankrupt because of medical bills,” said Neera Tanden, president of the Center for American Progress, which helped work for passage of the law. “It won’t happen in the first day or the first year, but when the law is fully operational, it will provide an economic benefit to roughly 30 million Americans.”
Tanden cautioned against rushing to judge the marketplace’s success on its first-day performance.
Numerous observers have predicted bugs and setbacks. Outreach workers in many states are having trouble getting the certification they need to start helping people enroll.
Many states predict that people will test the online application system, but actually sign up closer to Dec. 15, which is the deadline for coverage that starts on Jan. 1. Customers have until the end of March to sign up to avoid tax penalties.
Looming as one of the biggest challenges to the law’s success is the ability of insurers to persuade relatively young and healthy people to buy insurance to balance the costs for sicker people who are likely to get coverage quickly.
Under the law, health insurance companies can no longer deny coverage for pre-existing medical conditions and cannot impose lifetime caps on coverage. They also must cover a list of essential services, ranging from mental health treatment to maternity services.
Another obstacle: Nearly three-fourths of people under 65 who lack insurance are unaware the marketplaces opened yesterday, according to a Kaiser Family Foundation survey released over the weekend.
Spending money to raise awareness with ad campaigns has varied vastly, with some Republican-led states doing little or no promotion.
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