With less than 100 days remaining until the state health care exchanges go into effect across the country, the Affordable Care Act, or the so-called “Obamacare,” is now here. But what are these health care exchanges and what implications does this provision of the law have on the goal of getting 7 million people insured by 2014? With President Obama’s domestic policy gravitas and subsequent legacy hanging in the balance, let’s unpack this aspect of Obamacare.
First, the health care exchanges are a result of a federalist debate that has taken place since the beginning stages of this policy proposal, with roots stretching back to the inception of the Tenth amendment. Essentially, the Obama administration sought to include states in the process of a national health care system, rather than typical nationalized health care systems remaining mostly centralized at the higher levels of government. These exchanges are quite simply a marketplace to shop for subsidized health policies. They are supposed to encourage competition among health care providers to provide the most affordable plans and also transparency for health care shoppers to know what the options are, side-by-side.
There is a snafu, however, with this massive new policy. There is a deadline for enrollment. With 26 states currently opting to let the federal government run their exchanges and 7 states partnering with the federal government, there have been several benchmarks and deadlines missed both by states and the federal government. From consumer eligibility to training of new health care personnel, the frequent missteps and falling behind by the federal and state governments all support Republicans’ critiques of the policy, claiming this was a mistake from the start. Partisan fodder aside, these issues are causing other problems for the imminent implementation of this first major step in the new health care policy.
In light of the administrative errors and missed deadlines, the fair question can be asked: Will the marketplaces even be set up in time to offer health care to millions of uninsured people? According to Department of Health and Human Services Secretary Kathleen Sebelius, the answer to that question is a resounding, “yes.”
However, her legacy is on the line here too. The entire Obama administration has put comprehensive national health care reform at the top of its agenda since Day 1 in the White House and now that the time is nearing for the exchanges to be implemented, the ball is looking like it may be dropped.
Regardless of the snafus, scheduling issues, and even falling behind in proper training, one thing is certain – Obamacare appears to be here to stay. Whether or not you like it or voted for it, the days of repealing of the massive law appear to be over. The question now is: How big of a mess will it be when it enters the all-important implementation phase of policy creation?
On October 1, we will see.