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Obamacare: Will the Trains Run on Time?

If you have not been sick lately, you may not be aware that Obamacare is actually already being implemented, and the implementation is going fairly smoothly.
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If you have not been sick lately, you may not be aware that Obamacare (The Affordable Care Act) is actually already being implemented, and the implementation is going fairly smoothly. Adult children without health insurance are remaining on their parents' plans until age 26; children with pre-existing conditions cannot be turned down for coverage; everyone with insurance is getting free preventive care; seniors are seeing their drug prices go down; insurers are being forced to return money to policyholders and their rate increases are being scrutinized by state regulators. What remains to be implemented -- the state exchanges or marketplaces for the uninsured, individuals and small employers -- is on track to start enrollment in October of this year with coverage beginning in January 2014.

As we get closer to the October date, you will undoubtedly hear more doubts about whether or not the state marketplaces (and the ones run by the federal government in states that have refused to implement Obamacare) can actually meet the expected deadlines. New Mexico policymakers heard today that their exchange might be delayed, and many states are still debating whether or not to participate and run these exchanges or let the federal government do it for them. It's a dilemma for states with Republican governors who have declined to run a state marketplace. They are faced with a distasteful choice -- scramble to put together their own insurance marketplaces or let the feds do it. Neither choice is very palatable, and the foot dragging has been noticeable.

Where does that leave you? If you are lucky enough to live in California, New York or even Massachusetts (which already has an insurance marketplace), you will be able to sign up for insurance at an affordable rate come October of this year. If you live in one of the states that will have a federally run insurance marketplace because your state legislature declined to organize one of these marketplaces, you will also have the opportunity to enroll in plans that include the federally mandated "essential benefits." There may be some glitches, some misinformation, some delays -- but by January of next year, you should be able to sign up for meaningful coverage in your state.

But if you are expecting that coverage will be free or nearly so, you will be greatly disappointed. First of all, the benefits to which you will have access are more generous than what you would have without Obamacare. You will have access to maternity benefits, mental health services, rehabilitation treatment -- all services that are sometimes excluded from private coverage. But you will have to pay a premium that is proportional to your income. It cannot exceed 9.5 percent of your income if you earn between 300 percent and 400 percent of the Federal Poverty Limit and may be considerably less if your income falls below that level. If you are young, you may pay more for coverage than you have in the past, but you will get better benefits with more security. If you are older but not quite eligible for Medicare, you will pay considerably less than you would have on the open market and you can't be turned down because you visited the doctor once when you were 48 years old. Buying insurance as an individual these days is not an easy task. Coverage is expensive, deductibles are high, benefits may be skimpy. Obamacare aims to eliminate those barriers. Coverage should be less expensive, deductibles will be regulated, out of pocket payments will be capped, and benefits will be relatively generous. (Note the hedging I am doing here... no one knows quite yet what the premiums will be because most plans have not yet revealed their prices. But we do know that there will be regulation of the amount of deductibles and we know what benefits will be offered.)

As the president noted at his press conference this week, there will be bumps in the road. Any large program like Obamacare will have a lot of moving parts to fit together. But there are going to be "helpers" to explain things, and the application form has been shortened from 21 pages to 3! A first for a government program, to be sure.

I guess the bottom line is that we all need a little patience as we see how this program rolls out in our own states. What we need to hold onto is the knowledge that we won't go broke because of medical bills, we will have a guarantee of a certain level of benefits, and if we already have insurance through our workplace or Medicare or Medicaid, we will continue to keep that coverage.

The trains will not be wrecked. They will run -- kind of like Amtrak -- more or less on time. But at least there will be trains!