As tough as it was to move the Affordable Care Act through Congress and the courts, the difficulty pales in comparison to the challenge to ensure the legislation works as planned when it becomes fully operational in January 2014. At stake are the efficiency of a $2 trillion health-care industry and the health prospects of millions of Americans who currently have little or no insurance.
As proponents correctly emphasize, the success of the law will depend on bringing into the health insurance market as many as possible of the 50 million or so citizens who are uninsured. The sound argument is that an expanded competitive market, offering a variety of affordable products, will draw new consumers, which in turn will expand the insurance pool, improve health, spread costs across the population, reduce the abuse of emergency services and restrain cost growth over time.
But the projected benefits won’t materialize unless a high percentage of new consumers buy into the reform process. For instance, to be competitive, a health exchange must attract enough insurers offering a variety of plans. Insurers also need a large consumer base to sell enough policies to make it worth the effort to participate and also to cover the cost of popular new benefits such as coverage for pre-existing conditions and for dependent children through age 26.
Recent reports show how massive a task of mobilization remains if the overhaul is to achieve the desired results. A Kaiser Family Foundation tracking poll this month found a majority of Americans and two-thirds of the uninsured lack the information to know how the reforms will affect them. The Associated Press recently detailed the lengthy and complex federal application process to qualify for benefits in the exchanges. Insurers also complain about the convoluted process of qualifying health plans to participate in an exchange.
Granted that federal administrators need to be cautious to avoid errors and reduce avenues for fraud and abuse (imagine the outrage if noncitizens, say, were to receive subsidies). The concern is that a cumbersome process plus lack of awareness will breed confusion and depress enrollment. The risk is real, given the population of uninsured generally is hard to reach and often unfamiliar with both government and industry procedures.
It is unfortunate that leadership in Ohio remains hostile to the reform law, which makes the challenge of rallying participation that more difficult. Yet of late, a broad range of interests — hospitals, chambers of commerce, insurers, citizens groups, religious and social service organizations — has converged to make a compelling case for Medicaid expansion. An even higher level of engagement is necessary now from all the players and state officials to mount an all-out campaign of public education that will make it easier in Ohio to navigate a fast-changing health-care environment.