Starting Oct. 1, more than 40 million Americans who lack medical insurance will have their first chance to sign up for coverage under the new system that has come to be known as Obamacare. That sets the gears in motion to begin what the president has promised will be a transformation of the nation’s entire health system — making it fairer, less costly and more effective at providing care.
But while Obama might have thought that signing the new law would begin a political healing process, the divisions three years later are as deep as ever.
Poll after poll has shown Americans remain skeptical and confused about Obamacare. And on the day enrollment opens, the federal government may shut down as part of a budget battle tied to a Republican effort to block the law’s implementation. But the law will move forward, in any case.
Having passed a test of its constitutionality before the Supreme Court, the law now faces an even more critical judgment — one that will be written in millions upon millions of individual stories.
Among the winners will be the uninsured, assuming the coverage they get proves to be affordable and adequate. Businesses facing a new requirement to provide insurance say they could be losers. Some people who buy their own insurance may pay more, while others may pay less. Hospitals and doctors welcome the fact that more patients will be able to pay their bills but worry the government will demand more say in what kind of care they provide.
“The law is entering a new phase where it becomes real,” Drew Altman, president of the Kaiser Family Foundation, said. “A lot is going to turn on how smooth the process is, whether people get coverage and whether they like the coverage they get.”
In coming months, clues will emerge on whether the system will succeed or fail: Will the new insurance marketplaces work as designed? Will enough Americans — especially young, healthy ones — sign up? Will patients be able to find enough primary-care doctors and specialists — and see the ones they trust?
“We’re now seeing that a lot of the exchanges probably will have very limited networks and very low reimbursements to providers” compared with the large employers’ plans, said Douglas Holtz-Eakin, a former head of the Congressional Budget Office who now heads the conservative American Action Forum think tank. “This is the Medicaid story: Sure, I’ve got insurance, but no one wants to see me, and so I go to the emergency room for regular care.”
Towson resident Aniela Russo will start a new job next month and likely make too much to stay on Medicaid, the state-federal health program for the poor. So she’ll have to turn to the health marketplace for coverage. “I’m going to be devastated if I can’t keep my doctor,” said Russo, who suffers from a genetic heart condition. “It really feels like a matter of life or death.”