Henry J. Aaron: Health Insurance Exchanges and the Affordable Care Act: What To Expect on October 1

Henry J. Aaron has what is probably the most realistic take on implementation of the Affordable Care Act that i have seen.

Health Insurance Exchanges and the Affordable Care Act: What To Expect on October 1:

Republicans are vociferously predicting that implementation of the [Affordable Care Act] will fail and simultaneously doing all they can to produce that outcome. They seek to stop spending to implement the law…. A state legislator in South Carolina even proposed that the state give tax credits to help defray any penalties state residents might incur from defying the federal law.

At one level, this effort will fail. Previously authorized spending will continue. The law will be implemented. But it will probably succeed in blocking additional funding that would smooth the roll-out of an admittedly complicated law.

So, what should Americans expect on October 1 when the health insurance exchanges, or marketplaces, open for business and individuals and small businesses try to buy insurance through them? Success or failure?

The not-so-simple answer is: Both! And everything in between….

Massachusetts proved [the process can work] when it implemented a law much like the Affordable Care Act. A Republican governor and a Democratic legislature, working with business and labor, showed that close-to-universal health insurance coverage is possible….

There is every reason to believe that similar successes will mark the roll-out of the Affordable Care Act in several states. To be sure, even the best efforts will not have eliminated bugs from the computer software…. As with any large-scale start up, plenty of errors will be made. But with a bit of time and patience…things can—and will—be made to work.

But not everywhere. Some state governments oppose implementation or are “slow-walking” measures they need to take to make the new law work…. [In the states] which opposition to the Affordable Care Act is widespread, 20 percent or more of the population is uninsured. In contrast, fewer than 10 percent of the populations are uninsured in [many of the states] which have set up health exchanges.

I hope I am wrong, but I fully anticipate that in many states, the roll-out of the Affordable Care Act is going to be marked by confusion, error, and legitimate complaining—most of it unnecessary. Some errors and complaints are inevitable when millions flood a new agency….

The spirit with which the inevitable problems of implementing a major new law are confronted is critical. With good will, various stake-holders will pitch in, pinpoint the problems, and, with time and patience, [will] fix them…

But it is not what will happen in those states where officials who have staked their reputations on predictions of failure…. Observers should keep in mind that when millions of people are applying for coverage, thousands of mistakes are inescapable. They should not lose sight of the fact that many of those mistakes will result from the uncooperative and obstructionist efforts by those who have refused to recognize that the Affordable Care Act is the law of the land and that law-abiding citizens obey the law.


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