Wednesday, May 6, 2015

Is Obamacare on the ropes? Not at all

Is Obamacare on the ropes? The Government Accountability Office recently reported that it is falling behind schedule. Insurance exchanges, which are the centerpiece of its coverage expansion, may not be ready by the planned October 1 start date.

Is Obamacare on the ropes? Not at all

Holding a sign saying "We Love ObamaCare" supporters of health care reform rally in front of the Supreme Court in Washington, Tuesday, March 27, 2012, as the court continued hearing arguments on the health care law signed by President Barack Obama. Go ahead, call it Obamacare. Obama’s re-election campaign has lifted an unofficial ban on using the opposition’s derisive term for his health care law. Democratic activists have been chanting, "We love Obamacare," in front of the Supreme Court. And the campaign is selling T-shirts and bumper stickers that proclaim: "I like Obamacare." (AP Photo/Charles Dharapak)
Holding a sign saying "We Love ObamaCare" supporters of health care reform rally in front of the Supreme Court in Washington, Tuesday, March 27, 2012, as the court continued hearing arguments on the health care law signed by President Barack Obama. Go ahead, call it Obamacare. Obama’s re-election campaign has lifted an unofficial ban on using the opposition’s derisive term for his health care law. Democratic activists have been chanting, "We love Obamacare," in front of the Supreme Court. And the campaign is selling T-shirts and bumper stickers that proclaim: "I like Obamacare." (AP Photo/Charles Dharapak)
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Is Obamacare on the ropes? The Government Accountability Office recently reported that it is falling behind schedule. Insurance exchanges, which are the centerpiece of its coverage expansion, may not be ready by the planned October 1 start date. 

The exchanges will be marketplaces through which individuals and small businesses buy policies. The law directs that they open for business on October 1 with the policies they sell becoming effective on January 1. But they may not be ready in time.

The GAO blamed much of the delay on the refusal by 34 states to establish their own exchanges. This has left the federal government with the burden of creating them. The law’s drafters had expected all but a handful of states to operate exchanges themselves. This unanticipated task is straining federal resources. (To read the full report, click here.)

The federal government faces its biggest challenge in developing the complex information technology infrastructure that will drive the exchanges. Tens of millions of consumers will visit their websites. The IT systems must determine which policies they qualify for, whether they are eligible for subsidies to reduce the cost, and whether the policies meet regulatory standards. This is a daunting challenge.

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To further complicate the federal task, several of the 34 states have dragged their feet in helping. Only 15 of them have agreed to cooperate actively. And even for them, ongoing coordination between the federal and state governments remains difficult.

Congressional Republicans have been quick to seize on the GAO findings. “We are seeing a rollout marred by missed deadlines and incomplete programs,” complained Darrell Issa (R-Calif.), chair of the House Oversight Committee. “This GAO report confirms our suspicions about the implementation of the health care law,” declared Sam Graves (R-Mo.), chair of the House Committee on Small Business.

But the critics are wrong on two counts. First, Obamacare’s troubles are no different than those of major health reform efforts of the past. Missed deadlines and delays are par for the course for any program this complex.

A new report from the Robert Wood Johnson Foundation compared Obamacare’s difficulties to the 2006 launch of Medicare Part D. That was the health reform initiative of President George W. Bush that added a prescription drug benefit.

The report found similar glitches in the two rollouts. For both, polls reflected initial public disapproval, the readiness of IT systems posed a major concern, states complained about regulatory and cost burdens, and many consumers were left confused. (To read the full report, click here.)

Mark McClellan, who oversaw the Part D launch for the Bush administration, has recounted several of the challenges he faced. They ranged from enrollment problems to wrongful coverage denials to IT systems that were still being tested up to the last minute and even after the program went into effect. Yet Part D overcame the obstacles and today provides drug coverage for tens of millions of beneficiaries.

And Medicare Part D was not the only health reform plan to have a rocky start in 2006. The rollout of Romneycare in Massachusetts, which formed the model for Obamacare, faced similar hurdles.

Second, the critics fail to mention that they have caused many of Obamacare’s problems. Congressional Republicans cut sizeable sums from the budget for Obamacare’s rollout and even tried to eliminate funding entirely. At the same time, many Republican governors have refused to establish state-based insurance exchanges, compounding the federal implementation challenge.

These Obamacare opponents are trying to have it both ways. They created major roadblocks and then complained that implementation is lagging. If they believe Obamacare is in trouble, they largely have themselves to blame.

Health reform is always complex because health care is complex. Just ask the leaders of George W. Bush’s health care team. But reforms can become lifesavers for millions of people. If the past is any guide, Obamacare, once it goes into effect, will be the same.


From Obamacare to Medicare to managed care, read more of The Field Clinic here >>

Professor, School of Law & Drexel School of Public Health
About this blog

The Field Clinic reports and analyzes health care laws, government policies, and political trends that are transforming the care we receive and the way we pay for it. Read more about our panel of bloggers here.

This blog is produced in partnership with Kaiser Health News, an editorially independent program of the Henry J. Kaiser Family Foundation, a nonprofit, nonpartisan health-policy research and communication organization not affiliated with Kaiser Permanente. Portions of this blog may also be found on Inquirer.com and in the Inquirer's Sunday Health Section.

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Robert I. Field, Ph.D., J.D., M.P.H. Professor, School of Law & Drexel School of Public Health
Jeffrey Brenner, MD Founder of the Camden Coalition of Healthcare Providers, Medical Director of the Urban Health Institute at Cooper University Healthcare
Andy Carter President & CEO, The Hospital & Healthsystem Assoc. of Pa.
Robert B. Doherty Senior Vice President of Governmental Affairs & Public Policy American College of Physicians
David Grande, MD, MPA Assistant Professor of Medicine at the University of Pennsylvania
Tine Hansen-Turton Chief Strategy Officer of Public Health Management Corporation
Drew A. Harris, DPM, MPH Director of Health Policy Program at the Jefferson School of Population Health
Antoinette Kraus Director of the Pennsylvania Health Access Network
Laval Miller-Wilson Executive Director of the Pennsylvania Health Law Project
David B. Nash, MD, MBA Founding Dean of the Jefferson School of Population Health
Mark V. Pauly, Ph.D. Professor of Health Care Management, Business Economics and Public Policy at The Wharton School
Howard J. Peterson, MHA Managing Partner of TRG Healthcare, a national healthcare consulting firm
Paula L. Stillman, MD, MBA Healthcare consultant with special expertise in population health and disease management
Elizabeth A. W. Williams Senior Vice President & Chief Communications Officer for Independence Blue Cross
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