Obamacare the myth, becomes Obamacare the reality

 

After more than three years of myths and misinformation, the reality of Obamacare dawns on Tuesday.

Despite one last gasp on Capitol Hill, the political fighting is over and the centerpiece of the new health care system will debut with the introduction of the “exchanges,” the online marketplaces where the uninsured can shop for coverage.

To clear your mind of all the hyperbole swirling around the Affordable Care Act, just remember these three metrics: 2 percent, 4 percent and 60 percent.

 

The 2 percent figure represents the portion of Americans who will be affected by the ACA in the first year. Those are the estimated 7 million uninsured who will choose to take part in the exchanges in 2014. That number will gradually grow to 27 million by 2018.

 

The 4 percent figure — as hard as this is to believe — signifies the small slice of businesses that might be impacted by Obamacare. Employers with less than 50 employees are exempt from the insurance requirements and that group represents 96 percent of all U.S. companies, including the self-employed. Of that 4 percent, according to the Small Business Administration most already provide insurance for their workforce and the number of employers forced to decide between offering benefits or paying a fine may be less than 1 percent. That provision has been delayed for one year.

 

The 60 percent defines the amount of uninsured Americans who will have a policy available to them on their state’s exchange that costs less than $100 a month. That percentage would be higher if certain states were not obstructing — some would say sabotaging — the implementation of the ACA.

 

Glitches likely

 

Will it work? I suspect we will see some computer glitches on Tuesday. The separate SHOP exchange for small businesses has already announced that it will be a month behind in going online, though hard-copy applications will be accepted in the meantime.

The ACA could become plagued by a series of problems. It could flop. We shall see.

The biggest barrier to success may be ignorance. Many polls show that a significant portion of the public is still unsure what Obamacare is all about. A disturbing number of Americans, bombarded with news about the dozens of attempts by the House to wipe out health care reform, actually believe that Obamacare was repealed. Confusion reigns as Day One approaches.

 

The bottom line is that the 2 percent, 4 percent and 60 percent parameters do not sound at all like the Obamacare that’s been described and demonized by critics since 2009.

President Obama deserves a large share of the blame for doing a terrible job of selling his signature political issue to the public. The media, particularly the cable TV news networks, have preferred partisan shouting matches rather than supplying substantive information.

I suspect Obama avoided citing that 2 percent figure, which would have calmed many naysayers, because it makes Obamacare sound rather small and insignificant.

But I also suspect that the ACA critics wanted to steer clear of debating a plan that addresses the nation’s embarrassing number of uninsured by providing a competitive, private sector marketplace that offers tax breaks to make health care affordable.

The reality is that Obamacare will launch on Tuesday, with the start of the enrollment period, and over the following days millions of Americans may take a look around, bewildered, and ask: What was all the shouting about?

 

Dire predictions wrong

 

The vast majority of Americans receive their health insurance from their employer or from Medicare. The Obamacare exchanges have virtually nothing to do with that bloc of 200 million people. For those who have no coverage, the ACA offers a place to shop online that is based on web-based marketing innovations such as Travelocity.com.

There are no “death panels.” This is not a “government takeover.” It’s not a “job killer.” The latest canard to arise is that members of Congress exempted themselves from the Obamacare exchanges. The fact-checking websites have been stunned by the amount of blatant distortions and false information surrounding this one issue.

As the president said the other day, one Capitol Hill lawmaker called the ACA the worst piece of legislation in U.S. history, and another said the reforms would result in the deaths of women, children and senior citizens.

 

The more rational dire predictions also have been proved wrong. Insurers are vitally interested in participating on the exchanges. In Macomb County and surrounding metro Detroit communities, 50 plans will be available for the exchange shoppers, which is 49 more choices than most of us are ever offered by our employers.

The exchange prices offered, in state after state, have fallen below even the optimistic projections by the White House. And once-skeptical governors, perhaps influenced by Rick Snyder, have embraced the ACA’s expansion of Medicaid to cover the “working poor.”

Perhaps the biggest surprise is that the new mandates placed on insurers to weed out the junk policies that actually don’t “insure” much of anything has not resulted in a price spike for employer-based coverage.

 

Health care cost increases for families dipped below 4 percent for the fifth straight year, according to the latest study published in the October issue of Health Affairs. That has never happened before in the 50 years that these stats have been compiled. 

As the nonpartisan Kaiser Family Foundation reported, the reasons for this flattening of the cost curve is still up for debate but, historically, big annual increases tend to subside when Washington starts talking about a health care overhaul.

Another overlooked factor in this dwindling debate is that the coverage offered through the exchanges, due to 10 mandates from the Obama administration, such as required maternity care, mental health services and pediatric dental and vision care, is extraordinarily good.

Obviously, deductibles and co-pays will come into play as the area’s uninsured sort through those 50 plans. But one Lansing-based health care expert said last week that the amount of coverage on the exchange plans in Michigan is beyond anything offered on the individual market — at any price.

 

Obstinate employers hurt implementation

 

One obvious downside to the way Obamacare is playing out is that a small sliver of employers who offer little or no health benefits are attempting to dodge the system by reducing their workers’ hours to 30 per week. That puts these employees in part-time status and allows the company to avoid the ACA mandates.

But I suspect this charade will eventually end as employers face up to the realities of the new system, and either they will bow to public pressure or Washington will fix this loophole.

One survey found that the number of employers considering elimination of their health care benefits, which would send their workers to the exchanges, has plummeted from 28 percent in 2011 to 9 percent now. Two other business surveys placed the number of companies thinking about ending their benefits at 2 percent and 0.5 percent, respectively.

 

The opposition to Obamacare is fading where it matters most— in the workplace and across the nation’s economic landscape. In terms of pure politics, many in Congress who are still attempting to derail the ACA have seized on the president’s dipping popularity as he stumbles his way through the first nine months of his second term in office.

But Obama sounded confident in a speech last week about the fate of what critics call Obamacare, a label that he has embraced.

 

“Once it’s working really well, I guarantee you they will not call it Obamacare,” he said, drawing laughter from the supportive crowd. “… A few years from now, when people are using this to get coverage and everybody is feeling pretty good about all the choices and competition that they’ve got, there are going to be a whole bunch of folks (in Congress) who say, yes, I always thought this provision was excellent. I voted for that thing. You watch …. It will not be called Obamacare.”

 

Whatever it’s called, it’s here to stay. And if it works well, Obama will have earned the right to shout out the biggest I-Told-You-So in the history of I-Told-You-Sos.