The first day of October will bring a new day in health care, the health exchange. Depending on whom you believe, this could be a point of no return of some sort.
Conservatives have set the exchanges up as virtually a death knell of American freedoms. Government is taking over; coming between you and your doctor (hospital, pharmacist, etc.); making you pay for benefits you never, ever will need. Sign up to enroll in the exchanges, and you might as well be an enabler, aiding and abetting the encroachment.
At the other end of the spectrum, liberal supporters of exchanges make them sound like a cure-all — as if insurance companies will lose the upper hand in calling the coverage shots and dignity will be restored to long-suffering consumers. Disqualified for coverage because of pre-existing conditions? Scared to quit a job for fear of losing employer coverage? Sick child has hit maximum lifetime coverage? Employer does not offer insurance? Premiums jacked up when you make a huge claim? The solution is within reach.
After all the impassioned arguments (and exaggerated claims) about what will or will not be accomplish, it is easy to get the impression that the health-care system is about to be up-ended with the rollout of the new exchanges.
It would be a misleading impression. For all the emotion spent debating the impact of the exchanges, the reality is they are likely to affect a small segment of the population. The people for whom the exchanges may qualify as a game-changer are those who buy health insurance on their own, with no third-party involvement; those who do not now have any health coverage; and small companies with 50 or fewer full-time workers.
Thus, for the vast majority of Americans whose health coverage flows through employers (including local and state public institutions), Medicare, Medicaid, military and veteran services, the battle over the exchanges amounts to so much background noise. Without question, health care as we know it is changing fast, but for the majority of us, it isn’t because an online system of buying coverage is going live.
The open-enrollment period starts Oct. 1 and ends March 31. The unusually lengthy open season is a fair assessment of the slow and difficult process officials anticipate for fixing technical bugs, outreach and education campaigns, verifying income eligibility and all the other problems associated with rolling out a national program. Federal analysts anticipate the effort enrolling about 7 million in the first year. Other projections range between 4 million and 8.5 million for the first year, the count rising to 31 million enrollees by 2018.
Consider that the number of Americans who have no insurance is estimated at 48.6 million this year, and one must admit that by itself, the health-exchange experiment is a rather modest remedy for a very big problem. A hugely successful first year of enrollment, say 10 million, will leave some 38.6 million of the uninsured still out in search of other sources of coverage.
Lost, too, in the shouting about a “government takeover” and a “socialist” agenda is a fact hiding in plain sight: The insurance companies that are applying to compete on the exchanges all are private entities, operating on behalf of their clients and owners and not as proxies for any government, competing with each other pretty much as they do now.
It bears recalling that during the crafting of the Affordable Care Act, the White House took pains early to block a public, government-run option, to the abiding annoyance of its liberal supporters. Also, insurance companies remain the staunchest supporters of the exchanges, primarily because the concept expands the private commercial market. Small as the numbers may be in relation to the uninsured population, if the enrollment projections hold true, insurance companies are assured of millions of new profit-generating consumers.
In 33 states, Ohio included, where opposition has been loudest against a government takeover of health care, legislators have left the federal government responsible in whole or in part for setting up and managing the state exchange. Apparently, they find nothing alarming in that.
The health-care system is neither about to implode nor to resolve all that ails it. The part of the makeover that launches on Oct. 1 is a critical effort, but modest all the same, at addressing a huge problem.
Ofobike is the Beacon Journal chief editorial writer. She can be reached at 330-996-3513 or by email at email@example.com