A year after a titanic partisan battle in Congress yielded a 2,073-page statute, the law exists in what one seasoned health-care lobbyist called “a very weird place. It’s like we have two worlds.”
In one, federal officials are working at a fevered pace, writing regulations, planning innovations for the delivery of care, and giving states grants and guidance. That complex work is “even a little ahead” of expectations, said Urban Institute President Robert D. Reischauer, an authority on health-care policy.
In the other world, Reischauer said, the future “is very uncertain right now. . . . Today, I wouldn’t give much more than a 50-50 chance that all of the critical components of the Affordable Care Act will be alive and well . . . . Court decisions, defunding efforts or actual repeal of some major provisions could eviscerate the dreams of universal coverage and restrained cost growth.”
The administration is trying to focus attention on the parts of the law that have taken effect earliest, though the number of people helped so far is relatively small — or unknown.
For instance, nearly 12,500 Americans have joined high-risk pools that were created to cover people who were rejected by insurance companies because of medical problems. The enrollment so far is about 3 percent of government forecasts.
The White House is touting figures showing that nearly 4 million older Americans on Medicare with especially large prescription-drug expenses received $250 rebate checks last year, the first installment of a coverage gap that will be closed over several years. That is about one in eight people with the program’s drug benefit.
Other parts of the law that took effect last fall allowed young adults to remain on their parents’ insurance policies longer and have forbidden insurers to deny coverage to sick children. No one knows how many people either provision is helping.
In lieu of data, administration officials are spotlighting testimonials from people who have been helped — including in this week’s gatherings nationwide. Uwe E. Reinhardt, a health economist at Princeton University, said such anecdotes “have very powerful amplifying effects if they are powerfully told.”
One central test for the law will come in the 2012 elections: If Republicans win the White House or sweep Congress, “they can take this thing apart,” said Robert Laszewski, an analyst and consultant with clients across the health-care industry. Ethan Rome, executive director of Health Care for America Now, a grass-roots coalition supporting the law, said that undermining it has become a “near-psychotic obsession” for Republicans.