Welcome to Health Reform Watch, Sarah Kliff’s regular look at how the Affordable Care Act is changing the American health-care system — and being changed by it. You can reach Sarah with questions, comments and suggestions here. Check back every Monday, Wednesday and Friday afternoon for the latest edition, and read previous columns here.
Days until marketplaces launch: 36.
Oct. 1 has become a pivotal date in the media coverage of the Affordable Care Act. It's the day, as any regular reader of this column knows, that the health insurance marketplaces open for business. It's the day that I'm counting down to at the top of this column, and one that the White House says marks the start of Obamacare.
That's one way to think about it. Here's another: Oct. 1 is a completely arbitrary date, one that never shows up in the text of the Affordable Care Act and that has little bearing on the health law's success or failure.
As I spent time reporting my most recent article -- checking in with state marketplaces -- it became increasingly clear that their big day isn't necessarily Oct. 1. Instead, it's Jan. 1, the day that the individual mandate takes effect and any plans purchased on the marketplace actually kick in.
The space between October and December is viewed, by many standing up the health care law, as as soft launch: the time to make their new Web sites live, sort out the kinks and get the site in prime condition for the beginning of 2014.
The Affordable Care Act never set an open enrollment period. It directed the secretary of Health and Human Services to set "an initial open enrollment." HHS Secretary Kathleen Sebelius's agency set Oct. 1 through March 31 as the initial period when Americans purchase coverage.
Open enrollment begins in October, but any health insurance coverage sold on the marketplaces cannot take effect until Jan. 1, 2014. So, on the exchanges, there's no difference in when you begin to receive coverage whether you buy it this Thanksgiving, Christmas or New Year's Eve.
This is why states seem relatively okay with using the first few months of open enrollment as a test period: Even if there are kinks in October, they don't expect it to hamper residents' ability to purchase a plan by Dec. 31.
Oregon recently decided to open its marketplace only to registered brokers and community assisters on Oct. 1, waiting a few weeks until letting the general public in. Just how many weeks is still undecided.
"Even if we don't go live in the third week or fourth week, that will still give people plenty of time to go on and find a plan," says Amy Fauver, a spokeswoman for the exchange Cover Oregon.
Fauver says that the decision to delay public access to Cover Oregon wasn't about capacity; the site could handle heavy traffic. Instead, the agency wanted to have a beta launch, giving a small group of users access first.
"When Google launched Gmail you had to be invited" Fauver says. "That was their beta launch. That was their way to identify bugs. Our benefit is that our initial users will be community partners who will be trained on the system."
One big unknown for states is how many people will head to the marketplace during this soft launch phase. Numerous consumer marketing campaigns are underway, and there will no doubt be copious media coverage when the switch gets flipped on the first of October.
At the same time, there's little financial incentive to buy coverage in October that won't take effect in January. Some experts I've interviewed expect that there won't be heavy take-up until January, or even March of next year, when the individual mandate is in effect and open enrollment nears its end. It's hard to know because the country has never done something like this before.
Any kinks during the October soft launch will matter: These will the be first reports of how easy – or difficult – it is for consumers to purchase coverage under the new health care law. Will difficulties derail the entire law and its launch? In Oregon, among the states that have been most aggressive in setting up the health care law, they don't think so.
I think about Oct. 1 as our first glimpse at Obamacare in action, which is why I'm keeping the countdown at the top of this column. But we won't see Obamacare's programs kick in or the version of the exchanges that most of the Americans gaining coverage will ultimately interact with until the beginning of the new year.
KLIFF NOTES: Top health policy reads from around the Web.
Judging Obamacare: A how-to guide. "Despite what the Beltway crowd would have you believe, Obamacare won't be the only factor driving insurance costs in the years to come. In many cases, it won't even be the most important one. Instead, economics, demographics, and technology will often be in the driver's seat." Patrick Reis and Clara Ritger in National Journal.
Obamacare lobbying efforts intensifying, have little odds of success. "Restaurants want to increase the number of hours that define a full-time worker. Unionized electrical workers are seeking to change the treatment of health plans offered by multiple employers. Medical device companies hope to end a tax against them even though they are already paying that tax. Lobbyists face slim odds of getting any additional changes to the law before October 1, when millions of Americans will be able to sign up for subsidized health insurance through online exchanges in each state." Lewis Krauskopf, Reuters.
How to charge $564 for six liters of saltwater. "Some of the patients’ bills would later include markups of 100 to 200 times the manufacturer’s price, not counting separate charges for 'IV administration.' And on other bills, a bundled charge for 'IV therapy' was almost 1,000 times the official cost of the solution." Nina Bernstein in the New York Times.