Sunday, March 30, 2014

March 31 Is Only The Beginning

I suppose it would have been fitting if the Obama Administration had scheduled April Fool's Day as the last day to sign up for health insurance under the Affordable Care Act. We've certainly been treated to a smorgasbord of ineptitude, shifting deadlines, executive pronouncements that let certain economic sectors off the hook, and some rude, disrespectful, sometimes hateful objections from the right wing about the entire business.

That's why March 31 is so important. It represents the end of the first, and possibly most vital, stage of the implementation of the act. Millions of people have signed up for heath insurance. Millions of others are now covered by Medicaid. The federal and state websites are still balky, but they work. The end of the beginning is upon us. It can only get better from here. And the best part is that the law is working.

Republicans have dropped their demand that the law be scrapped, which six months ago looked like a possibility as they shut down the government and showed exactly what can go wrong when the government attempts to shortchange the software cycle. Now the arguments are that the law needs to be fixed, although GOP candidates are running against it to the exclusion of everything else, except perhaps voter ID laws that will guarantee a Republican majority in the House for the foreseeable future. Even Democrats in tossup races in Louisiana and North Carolina are talking about fixing the law so it doesn't ensnare the middle class and endanger employer-provided health insurance.

The problem is that, over time, that's exactly what the law will accomplish. We are moving into uncharted waters, where the employer mandate will shift and companies will start to drop health insurance from their benefit plans. How this will work is the key. Will companies give employees a voucher with a dollar amount attached to it to buy insurance? Will they raise wages so people can pay for their own policies? Will insurance companies bring down the cost of policies so they can remain viable? Will we eventually get a public option that takes private insurance out of the economy? These are the questions that will define how successfully the ACA reforms the health care industry. Follow the money. That's always been the gold standard of social change.

My sense is that employer-sponsored health insurance will be gone from most industries within 7-10 years, and the fallout won't be as bad as some have predicted. Companies have a vital interest in the health of their workers and insurance companies won't want to price people out of plans. Without the major expense of providing health insurance, companies will be able to pay workers more, though not too much more. The minimum wage will be less of a burden as it rises. Workers will need to make healthier choices and get checked more often before health issues become major concerns. The GOP calls this personal responsibility, and they accuse the Democrats of coddling the country with social programs. The ACA will do more for people taking control of their health than anything we've done in the United States. Remembers, the ACA is based on Republican ideas. That's why the law is both a curse and a blessing.

All of that is in the future. For now, President Obama's approval numbers are in the tank. History will remember him far more positively.

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