The insurance exchange system — the cornerstone provision of the Affordable Care Act — is undoubtedly the most important and most hotly debated element of the health care reform. After all, the online marketplaces are the most far-reaching change to the American health system in decades.
Given the sweeping social, economic, and political ramifications of the individual insurance mandate that requires everyone — except those who qualify for a hardship exemption — to purchase coverage, the law has had a rocky history. Its passage in 2010 came without a single Republican vote, challenges to the law put the constitutionality of the individual mandate on the docket of the Supreme Court, and the glitch-riddled rollout of the insurance exchanges in October put the viability of the reform in question.
But the largest test of the Affordable Care Act is now upon the Obama administration: As of January 1, Americans will be using the coverage offered through the exchange system.
If those policies are deemed to be affordable and the coverage judged to be good, the tenor of the entire debate could change. But to alter the narrative, the experiences of Americans who benefit from the Obamacare-mandated changes to the insurance system — including those low- and middle-income earners qualifying for subsidies and those with preexisting conditions who cannot be turned away by insurers — will have to outweigh the burden the reform could place on those who find their premiums too expensive, desired doctors out of their network, and deductibles too high.
While the design flaws and software problems that marred the launch of the federal insurance exchanges are a dark moment in Obamacare history, Democratic pollster Joel Benenson has argued that glitch-riddled rollout will have little to do with how Americans evaluate the reform in the future.
He told Politico that most Americans “want leaders in Washington taking actions that will strengthen their economic security and keep growing jobs and our economy,” an indication that the Obama administration thinks the Affordable Care Act is still an important part of its economic security agenda. “The only people obsessed with the ACA rollout today are Washington insiders,” he said, adding that “we have had a presidential campaign and a year in Congress where those who advocated for repeal of Obamacare lost.”
The Obama administration also has a few more loose ends to tie up before the battle for public opinion can be left to the quality and affordability of the exchange insurance policies. In the past few weeks, worries grew that January 1 — the day when both private coverage purchased through the exchanges and newly expanded Medicaid program began — would be as problem-filled as the early days after the October launch of the insurance marketplaces.
However, concerns that policyholders would show up to doctors’ offices only to find their enrollment did not go through or that the care they needed was not covered by their plan did not materialize. Once several weeks pass without incident, the Affordable Care Act discussion will become “a more granular-level debate that will focus on the price and the quality of the plans,” as former Obama spokesman Ben LaBolt told Politico. “Republicans will focus on people whose costs went up, Democrats will focus on people who didn’t have coverage before who had it now.”
In order to guide the conversation regarding the price and the quality of the plans, the administration has renewed its public relations efforts. To Americans in a quandary over whether to enroll in an Obamacare-compliant insurance policy or pay the federal tax penalty, hard enrollment numbers are far less important to their decision-making process than how satisfied those that have purchased a plan are with its coverage and affordability.
That is why the White House is organizing an offensive that will highlight the stories of Obamacare enrollees who were finally able to receive treatment for ailments thanks to their new coverage — or in other words, the success stories that will convince voters that the reform should not be repealed.
But there a few lingering problems to be addressed. Challenges to the requirement that all health plans offer contraceptive services have reached the Supreme Court, and outrage remains over the policies canceled by insurers because the coverage did not meet Obamacare minimum standards.
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