WASHINGTON — Three months before uninsured people can start shopping for coverage, some big unknowns loom over President Obama’s health-care overhaul.
The surprise announcement this past week that the White House is delaying a requirement that many employers offer coverage raised questions about other major parts of the expansion of society’s safety net.
One delay may not matter much in the end. People will judge the law on three main points: premiums, choice and the overall consumer experience.
Only partial answers can be gleaned now, and they don’t necessarily fall along predictable lines.
The rollout might go well in mostly Democratic states that prepared, while it clatters and clunks in mainly Republican ones that resisted Obama’s law. Millions of poor people will be denied coverage next year because they live in states that are refusing the law’s Medicaid expansion. But most workers now covered at work shouldn't see major changes.
A closer look at the three big questions:
The administration sees encouraging signs in states that have released premiums for next year, as well as from rates filed directly with the federal government but not yet publicly revealed.
“We are seeing increased choice and affordable premiums,” said Mike Hash, head of the Department of Health and Human Services’ health reform office.
But what will consumers see?
The data-crunching company Avalere Health found that in nine states that have released premiums, the rates appear to be lower than the Congressional Budget Office estimated when the law was being drafted in 2009.
But Avalere vice president Caroline Pearson acknowledges that doesn’t represent the cost comparison a consumer might make. Most people who now buy policies individually could see an increase from what they’re now paying. “The benefit design is going to be richer than what is typically purchased and available today ... and the rules require insurers to sell a policy to whoever wants it, regardless of health status,” she said.
That still doesn’t get you to the bottom line because most consumers will be eligible for income-based tax credits to help pay premiums. The plan they pick also could make a big difference.
Jeremy Gilchrist, a self-employed meteorologist from Winooski, Vt., has been uninsured about four years. In his mid-30s, he’s in good health and says he can’t afford premiums on a skimpy budget.
According to the online Kaiser Family Foundation’s health reform subsidy calculator, Gilchrist would be eligible for a tax credit of nearly $2,000 on a standard “silver” policy that costs $3,000, leaving him with $1,000 to pay. He can also take that $2,000 tax credit and use it to buy a cheaper policy called a “bronze” plan, leaving him with only about $500 to pay annually.
The typical Medicare recipient has about 30 private insurance plans from which to choose. There may not be nearly as much choice for families and individuals under the health-care law. It’s partly because in most states a single insurance company currently controls more than half the market for individual coverage.
The administration says that’s going to change for the better. In three-quarters of the markets the federal government will run, there will be at least one new insurer. But areas of concern are emerging. New Hampshire could end up with just one insurance company offering plans through the new marketplace. In 36 of Mississippi’s 82 counties, no insurer has yet signed up to offer coverage.
For people without job-based coverage, shopping for insurance under the new system is supposed to be as smooth as using a major online site such as Travelocity or Expedia.
But in a recent report, the Government Accountability Office raised concerns about the sheer technological complexity of the task and the short time left to accomplish it.
The goal is for consumers to be able to find out the amount of the tax credit they’re entitled to and sign up for a plan in real time or close to it. For that to happen, the computer systems of several major federal agencies, the states and dozens of insurance companies have to be able to talk each other, and the information exchanged must be accurate.
Testing the connections is underway. “We really feel very much on target for Oct. 1 and ready for open enrollment,” said a top HHS official overseeing the rollout. “We are meeting critical implementation deadlines.”