The Affordable Care Act , a.k.a., Obamacare, is “one of the most complex laws ever” to pass the Congress, in the words of one, pro-ACA analyst I link to below. The law is supposed to give many more Americans access to health insurance, slow the growth of health care spending costs, and simultaneously improve health care quality – all without fundamentally altering our private system of medical care and insurance. As if that’s not enough of a challenge, the law is grafted on to our current chaotic health care system, because reforming the system by simplifying it (say,. With single payer) was impossible politically. You know, onto the system that generated all of the problems Obamacare is designed to solve. It also has to do all of this without overburdening individuals, businesses, and powerful interest groups; and with zero cooperation from the other major political party at any level of government even though implementation depends hugely on the cooperation and competence of state governments.
What could go wrong? Well, it’s hard to tell how well things are going when so much is being done outside of media scrutiny and when every glitch, large or trivial, gets trumpeted by the GOP as the law’s death knell. But, the problems of getting this behemoth operating smoothly are real, if easily overhyped. So, I thought we needed a meeting to update us on Obamacare’s implementation.
I imagine we’ll have a big crowd, so, I’ll keep my intro down to 15 minutes. But, I want to take that time to explain a few key things:
- Then major moving parts of the law and how they’re supposed to work together, emphasizing the changes due up in 2014; and
- The biggest obstacles to successfully implementing each major piece of the ACA, emphasizing both those inherent to the law’s complexity and ambition, and those caused or exacerbated by outside forces (including but not solely GOP opposition).
IMO, liberal commentators I read tend to understate the huge inherent challenges in implementing Obamacare, and conservatives prefer to ignore the impact of their own party’s efforts at sabotage.
DISCUSSION QUESTIONS –
- In a 3-4minute nutshell, what are the ABCs of Obamacare; i.e., (a) what are the big problems it is designed to solve and (b) how does it try to do so and with what major moving parts?
- Which of these big changes have taken effect already and which ones will come on stream in 2014?
- What are the largest obstacles to successfully implementing the law and the most likely parts to be implemented poorly? Why? On whom will success or failure depend?
- What would “failure” of the law, or success, look like? Who will be affected and who will not be affected?
- Can this complex a law work, period: Do too many things have to go right and exactly as expected? Since a simpler solution is off the table politically, what is the alternative? Can it work if indefinitely one entire political party at all levels will do anything to keep it from working?
Overviews of Problems/Issues –
- [Update: This is your #1 must-read ] A good overview of implementation issues (but scroll down through the first half of this article until you get to the health care discussion.)
- The four big problems. (focus on GOP sabotage and states’ noncooperation) Recommended.
- The five big problems (focus on the law itself, less on GOP opposition). Recommended.
- Relax. Implementation will NOT be so bad, even though inevitably it will be complicated and have problems. A must-read. More here, but read the first one.
Specific Issues (only if you want more detail) –
- State-Level Health Insurance Exchanges:
- Employer Mandate (that was just delayed until 2015):
- Medicaid expansion:
- Two-thirds of the 30 million new eligible for Medicaid won’t get it because GOP-controlled states are refusing to accept it.
Since it will come up:
Republican Alternatives to Obamacare –
- Their opposition to Obamacare is total and unprecedented and that matters a lot.
- Their alternatives are designed to achieve the exact opposite outcomes of Obamacare. Recommended.
NEXT WEEK: Are the culture wars finally dying?