The Obamacare that consumers will finally be able to sign up for next week is a long way from the health plan President Obama first pitched to the nation. As Politico notes, millions of low-income Americans won’t receive coverage. Many workers at small businesses won’t get a choice of insurance plans right away. Large employers won’t need to provide insurance for another year. Far more states than expected won’t run their own insurance marketplaces. And a growing number of workers won’t get to keep their employer-provided coverage. But, apart from that - and all the exemptions - six more days and we will all get to see the shiny new exchanges; which may (or may not) prove Sen. Barraso right when he said "It was bad policy and bad politics. They got it wrong on all accounts."
An example from Kentucky... the only state to fully embrace Obamacare...
[Why has it changed so much?]
Every branch of the federal government played a role in weakening the law over the past three years, the casualty of a divisive legislative fight, a surprise Supreme Court ruling, a complex implementation and an unrelenting political opposition.
The result has been a stark gap between the promise of Obamacare and the reality — one that has fueled a deep vein of skepticism about the law as it enters its most critical phase.
[Hope is back]
Obama will take a lead role during the six-month enrollment period in trying to convert critics...
His best defense against Republican repeal efforts is a robust consumer response, and his best hope to soften years of public antipathy is a successful rollout. That’s why Obama is asking millions of Americans to just give the law a chance — go to the Web, sign up for a health care plan starting Oct. 1 and claim a new benefit that’s there for the taking on Jan. 1.
The growth rate for health care costs has slowed to its lowest level in decades, although experts dispute whether the recession or Obamacare should receive the credit.
The broad pillars of Obamacare remain intact: the exchanges, the subsidies and the security of coverage for so many Americans who otherwise couldn’t afford it. But in ways large and small, the changes to the law are making the reality of health reform more challenging.
The Supreme Court set back coverage
Chief Justice John Roberts handed the Obama administration an unexpected victory last year with his 5-4 opinion upholding the law. Less understood at the time: the dramatic consequences for his split-the-difference solution that a mandatory Medicaid expansion must be an option for each state.
“It’s underappreciated how fundamentally the Supreme Court changed the law when it made Medicaid a state option,” said Drew Altman, president and chief executive officer of the Henry J. Kaiser Family Foundation. “The law that is being implemented is not really the law that passed the Congress.”
[Holes in coverage]
As written, the law required states to expand the Medicaid program to cover people who make up to 133 percent of the federal poverty level — or about $31,000 for a family of four. Now there will be a coverage gap for people who are too poor to qualify for federal subsidies to purchase insurance on the exchanges but not poor enough to access Medicaid in states where governors refused to broaden the program.
[The family glitch]
For instance, workers can opt out of their employer insurance — and go on the exchange — if their share of the premium is more than 9.5 percent of their household income. But the law calculates that based on the worker’s premium, not the whole family’s. Advocates of the law have dubbed that “the family glitch” — one that will limit coverage.
“Everyone knew it was complex,” said Alan Weil, executive director of the National Academy for State Health Policy. But as the law is actually put into practice, “you see more complexity than anyone thought when the law was passed.”
[The Democrats have changed it most...]
Despite more than three years of Republican efforts to stop Obamacare, the vast majority of changes to it have come from the Obama administration.
The White House delayed the employer mandate for at least a year to allow time to sort out the complicated reporting requirements. The administration also decided that the CLASS Act — a long-term care program championed by the late Sen. Ted Kennedy — was financially unsustainable.
A consumer protection — the limit on out-of-pocket health costs for individuals — was pushed back to 2015 after the administration heard that insurers and employers needed more time to comply. And in most states, workers at small businesses will have only one plan to choose from in the health exchanges next year, not the multiple choices they were supposed to have.
[and it's not getting any better]
Obama promised during the health care fight that people who liked their employer-provided coverage would be able to keep it. But several large employers have announced plans to curtail employer coverage, particularly for part-time workers.
[The Republicans remain distressed...]
“The Democrats were wrong on the law in terms of what it was going to do for the cost of care, and they were wrong on the law in terms of people’s opinions of it,” said Sen. John Barrasso (R-Wyo.), one of the Senate’s leading critics of the law. “It was bad policy and bad politics. They got it wrong on all accounts.”
[But Democratic hope prevails]
“We clearly needed a change. The law is not perfect. I don’t think there’s ever been a perfect law,” he said. “But we will see some things that will go very, very well and other things that will be less than anticipated.”