State insurance-buying exchanges — one of the centerpieces of President Obama’s controversial 2010 health care law — began their first open enrollment period Tuesday, an event that both supporters and opponents had been eagerly anticipating practically since the legislation was signed 31/2 years ago. For the first time, low- and moderate-income Americans who don’t have health benefits at work were able to sign up for comprehensive coverage at a discount, thanks to taxpayer subsidies that offset much of the costs.
The exchanges opened their doors as federal and state governments are still struggling to implement some important elements of the Patient Protection and Affordable Care Act, better known as Obamacare. Outside California, some exchanges aren’t yet ready to offer certain features, such as online sign-ups. And in several red states, elected officials are actively undermining the exchanges and their uninsured constituents’ ability to obtain coverage.
Add to that the misguided effort by congressional Republicans to “defund Obamacare,” and you have a lot of drama surrounding the exchanges’ debut. Still, the test of the exchanges’ viability — and the sustainability of the Affordable Care Act — isn’t what happened on Day One. It’s whether they attract a broad and deep pool of the previously uninsured by the time the enrollment period ends March 31.
The idea of an insurance exchange has broad bipartisan support because the concept is elegantly simple: Give people an easy way to compare and sign up for insurers’ offerings and that will increase competition, hold down premiums and expand coverage. The technical challenges are significant, however, because the exchanges’ computer systems have to inter-operate with those of federal, state and county governments and the health plans that are offering coverage.
The real challenge for Covered California and its counterparts will be getting their message out to the uninsured, then persuading younger, healthier individuals to pay for coverage that they have been content to live without until now.
That lack of awareness is one hurdle. Another is the relentless invective about Obamacare that’s reducing support for the law among the people who have the most to gain from it. But the exchanges have started telling the other side of the story, and their outreach began in earnest Tuesday.Los Angeles Times