It’s time to see Obamacare in action

09/25/2013 9:28 AM

09/25/2013 9:28 AM

It’s here.

In two weeks the nation will take the first concrete steps in a long-delayed experiment to overhaul its health care system. On Oct. 1, the online exchanges where the uninsured can shop for insurance will open.

I’ve previously pointed out the problems with the Affordable Care Act — aka Obamacare. As it was being debated in Congress, I wrote about health care experts and others offering alternative paths.

And earlier this year, it became obvious that the implementation of the act was stumbling, at best.

Besides issuing confusing guidance and missing deadlines, the administration has bent or ignored various provisions it expressly put into the act. The most-notable example: Congressional staffers are now off a key Obamacare cost hook.

But let’s now get to it. After all the yanking — the congressional fighting, the court decisions and the constant criticism over the individual mandate and more — let’s all stand aside and see whether this thing will work.

The public needs to get on the ball. In the latest Wall Street Journal/NBC News poll, nearly 70 percent of respondents said they didn’t understand the act or understood only part of it. Which really means they haven’t been paying attention.

Other polls show that the public agrees implementation is going poorly, but most think we should either spend more on getting the law in place or wait to see whether changes will be needed later.

Some businesses still complain that the act is overly complicated and they’re not getting clear direction from the administration, but most are figuring it out.

After all, businesses are generally led by smart people who already manage complexity. And it’s not as if the current health insurance system is easy to navigate in the first place.

Some businesses are going further down the road on health care reform than the supporters of the law may have intended. Taking advantage of the act, they’re getting out of the health insurance business altogether and the headaches it causes.

Sears Holdings Corp. and Darden Restaurants Inc. have decided to give their employees a fixed sum of money and direct them instead to an online exchange to buy insurance. IBM and Time Warner are dropping their retiree plans in favor of private exchanges.

And some insurance companies are setting up their own exchanges that will compete with government exchanges.

The law soon could end the historical accident of employers’ providing health insurance, which began as a way to reward and keep workers in response to World War II wage freezes.

For employees, buying health insurance will be like buying any other kind of insurance. And maybe insurers and health care providers will compete harder for their premium dollars.

For businesses that want to keep offering health insurance, as long as they meet the law’s minimum standards there’s little that would stop them from trying out more reforms.

More businesses are offering employees insurance incentives or levying penalties to encourage healthy behavior. They’re also encouraging the use of telemedicine.

And many are going to high-deductible coverage plans linked with health savings accounts. The idea is that consumers will be protected from catastrophic bills but pay more upfront for minor problems and routine care. Again, the hope is that doctors and hospitals will compete more on price.

Businesses can also continue to tackle the biggest gap in the law: its lack of controls on the soaring costs from hospitals and doctors.

They and insurers could do more to get price transparency from providers. Executives could tell the providers that to get their business, they will have to be more forthcoming on cost and outcomes so consumers can shop around efficiently.

Aside from never-to-be-convinced critics, the act is also taking fire from ostensible supporters.

Lower-income but uninsured consumers are concerned about its cost, despite the subsidies they will get. And they fear the complexity of the online exchanges. Some young people share similar worries.

Unions, which just last week lost an effort to get subsidies for lower-income union members, are complaining about the excise tax on so-called Cadillac insurance plans. And they’re concerned about the act’s setting the work week at 30 hours, leading some employers to push full-time workers to part time.

Teamster President James Hoffa recently sent a strident letter to the White House signed by several other union leaders that read in part: “The ACA will shatter not only our hard-earned health benefits, but destroy the foundation of the 40-hour work week that is the backbone of the American middle class.”

And Senate Democrats from states with medical device manufacturers have mounted attempts to repeal the Obamacare tax on such devices.

Why didn’t they raise such objections as the ACA was going through Congress?

To borrow a rhetorical tic: Look, any problems in the act — which is mainly designed to help the uninsured, many of them young — will be worked out over several years.

The work week provision may indeed have to be changed, but the taxes on Cadillac plans and medical devices are linchpins. Both were designed to prevent the overconsumption of treatment and defensive medicine that have been propelling health care costs and raising premiums — for everybody.

If the critics are right, the best case for drastically modifying the act or repealing it outright may come from seeing a bad law in action.

But for the time being, critics and obstructionists should stand down.

It’s too late now.


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