WASHINGTON — Contentious from its conception, President Barack Obama’s health care law survived the Supreme Court, a battle for the White House and rounds of budget brinkmanship. Now comes the ultimate test: the verdict of the American people.
A government shutdown could dampen the rollout today as insurance markets open around the country. But it won’t stop the main components of “Obamacare” from going live as scheduled, glitches and all.
The biggest expansion of society’s safety net since Medicare will be in the hands of consumers, and most of their concerns don’t revolve around ideology and policy details.
People want to know if they can afford the premiums, if the coverage will be solid, where the bureaucratic pitfalls are and if new federal and state websites will really demystify shopping for health insurance. Full answers may take months.
Slow start with bumps
Expect the rollout to get off to a slow start, with some bumps.
People who don’t have access to job-based health insurance can start shopping right away for subsidized private policies. Or they can wait to sign up as late as Dec. 15 and still get coverage by Jan. 1.
Many will probably want to see how it goes for the first wave of applicants before they jump in.
Glitches are likely to pop up in the new online insurance markets.
Over the weekend, several states were still struggling to get plan information to display accurately on their websites. Earlier, the federal government announced delays for small business and Spanish-language signups. A protracted government shutdown could slow needed technology fixes.
Consumers also could run into problems getting their right subsidy amounts.
People with complicated tax returns and extended families living under the same roof could find they need personal assistance to work out the issues. Referrals to state Medicaid programs might go smoothly in some states, not so well in others.
Eventually, at least half the nation’s nearly 50 million uninsured people are expected to get coverage through the Affordable Care Act, either through subsidized private plans sold in the new markets or an expanded version of Medicaid in states accepting it for low-income adults. Immigrants in the country illegally will be the largest group remaining uninsured.
People who do have access to employer-based plans also will see changes. Starting Jan. 1, virtually all Americans will have a legal obligation to carry health insurance or face fines.
Passing up the company medical plan in exchange for a bigger paycheck may no longer be an option. But employees who lose their jobs, entrepreneurs starting their own businesses and people in between school and work could have an easier time getting coverage.
Also as of Jan. 1, a pre-existing medical condition will no longer be a barrier to getting health insurance.
Polls show the country remains divided over the law, with opponents outnumbering supporters. Nonetheless, a Kaiser Family Foundation survey released over the weekend found 56 percent of Americans disapprove of cutting off funding to expand coverage for the uninsured, as congressional Republicans are pressing to do.
In states not expanding Medicaid, millions of uninsured people below the federal poverty level will likely be shut out of coverage. That’s the case in Texas and Florida — both of which have large uninsured populations — and in many, but not all, Republican-led states.
It’s because under the law, people below the poverty line — an individual making $11,490, a family of four $23,550 — can only get the new coverage through expanded Medicaid. And the Supreme Court gave states the right to opt out.