What's next for Obamacare?

7M enrolled doesn't guarantee health law's success.
Associated Press
Apr 5, 2014

Seven million people signed up, so there is an appetite for President Barack Obama's health care law, but that doesn't guarantee success for the country's newest social program

Big challenges are lurking for the next enrollment season, which starts Nov. 15. Chief among them are keeping premiums and other consumer costs in check, and overhauling an enrollment process that was advertised as customer-friendly but turned out to be an ordeal.

"They have demonstrated the law can work, but we are a ways off from being able to judge its success," said Larry Levitt, an expert on health insurance markets at the nonpartisan Kaiser Family Foundation.

Republican opponents of the law keep pushing for a repeal, but as millions of people obtain insurance, how long can the party's strategy remain a politically viable option?

"What the Republicans need to really pay attention to is what they would do different from the Affordable Care Act," said economist Gail Wilensky, who ran Medicare under President George H.W. Bush.

"Just talking about repeal is not going to make it with 7 million people getting insurance on the exchange. And it has to be something reasonably credible ... it can't just be repeal. We are beyond that."

The source of the pent-up demand that propelled health care sign-ups beyond expectations could stem from the nation's new economic reality: a shrinking middle class and many working people treading water in low-paying jobs.

Health insurance has been one of the pillars of middle-class security for decades. With fewer jobs these days that provide health benefits, there was an opening for a government program to subsidize private insurance.

Enter Obama.

When Medicare and Medicaid were created in the 1960s, policymakers took it for granted that people working steady jobs would have access to health care, said Len Nichols, director of the health policy center at George Mason University in Virginia.

That was "back in the day," Nichols said. "Our assumptions have been all along that you could buy what you needed. But you cannot. And that is why we are where we are."

It could take the rest of the year to sort out how many uninsured people have actually gotten coverage, the ultimate test of Obama's law.

Early statistics provided by the administration have not been useful, mingling uninsured people with those who previously had coverage.

But an ongoing Gallup survey has shown a steady drop in the share of Americans without insurance since Jan. 1, when the law's main coverage expansion took effect. Those numbers should improve because many people still can take advantage of extensions granted by the administration, and because those eligible for the law's Medicaid expansion can apply at any time.

Still, vindication for Obama's law isn't guaranteed. Among the top challenges:


Health insurance premiums tend to go up every year, so the question now is how much higher in 2015.

"How fast they go up will no doubt vary across the country," Levitt said. "Public judgment of the law will be influenced by how rapidly premiums rise."

There's a back-and-forth going on, he said. An improving economy and the law's taxes on insurers will tend to push up premiums. Mechanisms in the law to assist insurers with a disproportionately large share of high-cost patients will push down premiums.

The big unknown is what economic bets insurers made when they jumped into the markets created by the law. If they were conservative and figured a big share of costly cases among the newly insured, that would take some pressure off premiums for next year.

Another important affordability issue has to with deductibles and copayments that consumers have to pay when they use their insurance benefits. Many of the new plans have high out-of-pocket costs, a trade-off for keeping premiums low.

The advocacy group Families USA, which has supported the law from its inception, says the government should nudge insurers to cover more routine medical care outside of the annual plan deductible, the amount consumers pay before insurance kicks in. Right now it's mainly preventive services that are covered outside of the deductible.



One of the law's main goals was to take the mystery out of purchasing insurance, in the same way buying a car is less intimidating these days because prices, quality ratings and loan rates are easily available on the Internet.

But even when the websites are working, the insurance exchanges are anything but easy to navigate.

Finding out what hospitals and doctors are in particular plans requires additional work. Also, experts say it's really difficult to get to a true bottom-line estimate that includes premiums and expected cost-sharing.

"The promise has not been realized," said Robert Krughoff, president of Consumers' Checkbook, a rating service that evaluates health plans for members of Congress and federal employees. "The law says the exchanges will assist consumers in making easy plan choices, and that has not been realized. But it could be."

One common recommendation is to provide consumers with much more in-person assistance to enroll and pick a plan. A change that might help meet that goal is to align sign-up season with tax filing because that could enlist the help of tax preparers.

As it stands now, the administration has scheduled open enrollment season to end on Feb. 15, 2015, right around when most people are just starting to think about filing their taxes.

Krughoff says better online tools are needed to estimate costs and find hospitals and doctors.

"I do think there are many cases where consumers will have joined plans that will cost them a lot more than they could have," he said.



The Hero Zone's picture
The Hero Zone

You can't "make" someone responsible. This is perhaps the tenth time I have explained this to your authoritarian definition. Responsibility is internal and projected outwards. Responsibility must be taught, fostered, and encouraged to grow. It can never be legislated. Or are there no repeat criminal offenders that the law "made responsible" the first time? Come on Big Dog, you're better than this.

The Big Dog's back

Really? Why do we have a judicial system?

The Hero Zone's picture
The Hero Zone

To penalize irresponsible people. Some people learn responsibility in jail. Others don't because responsibility can't be compelled no matter how many schemes you hatch to impose behavior on people.

The Big Dog's back

We make them personally responsible for what they did. There, I said it for you. Now, that wasn't so bad was it?

The Hero Zone's picture
The Hero Zone

Why do we have guards then? Tag, you're it.


7M sign-ups?

Without a statistical breakdown it's just so much gobbledygook.

Typical of central planners to crow about quantity as opposed to quality.


The individual mandate amply demonstrates that it’s a FORCED authoritarian program.

“Political power grows out of the barrel of the gun...”

- Mao Zedong

Dinghy Gal

There is no appetite for this law. Just fear of fines for those who would normally not buy insurance and for those who already had and liked theirs and were cancelled. It will be another top heavy bureaucracy we are so good at creating. Crumble it will.

There you go again

Yep, 7m enrollees doesn't guarantee success.....but as long as Obama is talking/lying, it will be a "success". How long are we gonna accept this bologna?!?!

The Big Dog's back

Right wingnuts are going the way of the dinosaurs-EXTINCT!


Thank you for your example of well thought out points, that were well researched, and documented in your post. So many times we read posts from HZ and others that are just one line bumper sticker ads from the right wingnut handbook, but you took the time and effort to extend and expand your thought and give documented and linked for all to see and be convinced. Great job! Convincing to all who took the time to read all of it.


BRILLIANT!!!! What do you want to bet it parts his hair as it goes flying over his head?

Darwin's choice

This is more realistic.....http://www.foxbusiness.com/on-ai...



Oh, sure, there's "an appetite for" Obamacare just like paying your income taxes is "voluntary!"

I'd also note that, for those of you who think Obamacare is a fine plan that will improve access to healthcare and increase personal responsibility, we can use the identical methodology to fix:

1. Homelessness. MANDATE everybody buy a house! Doesn't matter whether or not it's affordable, it's the LAW!

2. Obsesity. MANDATE everybody get up every morning and exercise (shades of Communist China and North Korea, but especially in North Korea, they're thinner -- though I suspect famine helps with that).

3. Intolerance (racism, anti-gay, whatever). MANDATE nobody can think, say, or do anything that doesn't meet the criteria of the centralized progressive thinkers. The heck with freedom -- you're free to AGREE with me!

4. Education. Everybody is taught the same thing (whether it's above or below their capabilities, and whether or not it happens to be accurate -- uniformity matters more than content, you know!). And everybody gets an A! (Oh, wait, they're already doing a lot of that. Which, of course, probably explains why this country has fallen so many notches on quality of education lists.)

Gosh, Big Dog, Coasterfan, et al, what great plans! We can fix EVERYthing if we just mandate that there's no longer anything to be fixed!

The Big Dog's back

sam, turn around slowly and step back from the edge.

Darwin's choice

You're on a roll this morning dog! The neighbors leg humping lab pay you a visit?

The Hero Zone's picture
The Hero Zone

Sam you also forget when it comes to heath care we need to mandate regular blood donations and organ harvesting upon death. It's not fair that those with more/better/working substances are allowed to keep it from those that don't. Why are we letting those most in need suffer from the greedy few who got theirs but aren't sharing their piece of the pancreas? I have a right to your blood and organs, Sam, didn't you know?


Just the word Obama gets you right wing dingbats all fired up. I have yet to read one single post of how the law has negatively affected YOU!

The law is here to stay guys. Deal with it already!


If the law is here to stay why arent you mad at the only guy in government who has postponed parts of the law 38 times? If it is here to stay tell your god to quit stalling huge parts of it. Impose the entire law and see what happens in the next election.


Go lay down!!!!!!!!!


You just cannot help yourself from telling others what to do. Just because you need baby sat 24/7 doesn't mean everyone else does. Now run along and whine about how your god doesn't get his way dragging this country into the third world.


Not true, deertracker. SEVERAL people have posted comments on previous stories about their personal circumstances vs. unaffordably high Obamacare premiums. I'm one of them. As I recall, Big Dog accused me of LYING (he's wrong, but being accused by Big Dog of lying is like being accused by Obama of being a racist -- it's so ubiquitous, it's meaningless).

The law isn't here to stay. The only question is whether or not it will be here long enough to make the damages irreversible. Meanwhile, when you say "deal with it," I'd welcome your input as to just how somebody like me can "deal with it" when over $400 a month wouldn't mean "belt tightening." It would mean IMPOSSIBLE.

The Hero Zone's picture
The Hero Zone

To provide another example, anecdotal as it may be: one of my community members is paying $60 more per month for a low level plan that would otherwise have been offered through his job. He can't get it through the job because their plan "doesn't meet new regulations" yet the company through Presidential tweaks has not required businesses to comply. But those with old plans through tweaks again are grandfathered in so there is no current reason for the company to change, especially with this new "marketplace" people like this example can be dumped into.

The Big Dog's back

You just contradicted yourself.

The Hero Zone's picture
The Hero Zone

Continue your observation with why or how I am contradictory.


Geez you cranky old white oldsters, he got voted in. You folks try again in 2016. \uyd________


I heard POTUS's speeches on this. He is also including those who are able to stay om Mommy & Daddies insurance policy until age 26. He's really grasping for a lifeline.


It all depends on what they count and how they count it,for example...

In a recent survey commissioned by President Obama, his supporters have proven to be the most likely to have had sex in the shower. The survey was carried out for Democrats by a leading soap and toiletries firm. The results revealed that 86% of Obama supporters said that they have had sex in the shower. The remaining 14% said they haven't been to prison yet.