“We’re going to have an upside-down social program in these states” that do not expand Medicaid, said Massachusetts Institute of Technology economics professor Jonathan Gruber, who advised the administration on the law. “If you’re poor, you get nothing. If you cross the poverty line, you can get subsidies and buy into the exchanges.”
In Prince George’s County and Southern Maryland, Greater Baden Medical Services estimates that 40 percent of the patients at its community health facilities are uninsured. It will be working feverishly to help them sign up for coverage. But providers there have no idea how many more patients to expect, once the law kicks in Jan. 1.
“Nothing this big is going to happen without glitches,” said Sarah Leonard, who is about to retire as Greater Baden’s chief executive. “We know there’s a long line of people needing care. But how soon will they enroll? What will they expect or need? What other providers will there be for them? Those are some of the great unknowns.”
The health law’s success rests on Americans buying coverage en masse. Low enrollment could cause premiums to spike. But some young people already are planning on paying the penalty, rather than buying coverage by Jan. 1, as required.
A 26-year-old Arlington lawyer, who has $200,000 in student loans and works on contract for firms, figures his fine would be $600. That’s far less than the almost $1,700 a year he would pay for an inexpensive plan. “Money is tight and the income isn’t consistent,” he said, speaking anonymously so as not to hurt his search for a permanent job.
In fact, premiums have, so far, come in below government forecasts. But because of new rules, some young, healthy people with low rates may pay more than they do now, while some older, ailing consumers might pay less. And premiums are only part of the story. Some low-premium plans have high co-pays and deductibles.
Experts say it hasn’t been clear how consumers will react.
Now, America is about to learn.