A lot of people have been waiting for October 1, to see how Obamacare will work. If they're serious about trying to form a judgment, they're going to have to wait a lot longer.
Tuesday may be the first day of open enrollment for the new marketplaces. But there will be many more days to follow. Open enrollment lasts until the end of March and few people are likely to sign up right away. It will be months, at least, before we have a real sense of how well Obamacare is working. And of course that's only for the people buying coverage on their own. The vast majority of people, the ones who get insurance through an employer or Medicare or Medicaid, won't see visible changes at all.
But the critics aren't going to wait. Already, stories about Obamacare glitches are all over the place. More such stories are bound to appear. But how real are these glitches—and how serious? What’s the difference between a glitch and, say, an unfortunate side-effect? To help you make it through the next week, and maybe beyond, here’s a guide for understanding some of the stories you are about to read.
The websites crash.
Nobody expects all of the Obamacare websites to be fully functional on day one. And in theory that’s not such a big deal, given the long open enrollment period. But what if it’s November and the systems still aren’t working? Will people who get frustrated with the sites during their “beta launch” decide not to come back? What if the errors aren’t immediately visible—and people get incorrect information about subsidies initially, only to learn later that they are entitled to less or more money than they thought?
Fear factor: 7 (out of 10)
Don't worry: Big IT projects always have a lot of glitches. Just ask the kids who bought SimCity and had to wait weeks before it worked properly.
Worry: Those kids playing SimCity didn’t need health insurance. The people waiting for Obamacare do.
If things go badly, don't be surprised if...: The Department of Health and Human Services fires some government contractors—i.e., the ones building their websites—and hires a bunch of people to read paper applications.
The navigators get lost.
Under Obamacare, the federal and state governments have financed and educated non-profit groups to help people apply for insurance. Republicans have criticized the navigators, warning that they can’t be trusted with personal data. The concern is wildly overblown and, partly, these officials are doing the bidding of insurance agents and brokers who fear competition. But what if the navigators struggle with the system? What if they can’t help people get insurance?
Fear factor: 2
Don't worry: For the majority of people, shopping for insurance in the new marketplaces should be straightforward.
Worry: For a minority of people, it won’t be—and the navigators aren’t going to have much experience at this.
If things go badly, don't be surprised if...: Agents and brokers get more business.
Part-timers lose some time.
Stories of businesses forcing part-timers to work less than 30 hours are in wide circulation, enough to make clear that it’s a real phenomenon. But the aggregate numbers suggest it’s a small phenomenon. And while losing hours is bad, gaining health insurance is good.
Fear factor: 2
Don't worry: Given the size of the economy, and its normal fluctuations, these changes barely register.
Worry: Try telling that to somebody who just found out their hours, and paychecks, are going down.
If things go badly, don't be surprised if...: Bipartisanship breaks out on Capitol Hill, parties agree to modify employer requirement and replace the revenue with payment reforms in Medicare.
Taft-Hartley plans end up like Taft and Hartley—i.e., dead.
Some unions are unhappy because, they say, insurance reforms jeopardize the long-term viability of the plans they operate on behalf of members. The unions might suffer, at least in the short term, as they would have one less enticement for luring members. But in at least some cases both the workers and their employers might be better off, because the workers will get a better deal from the subsidies and employers will be better off without the burden of health insurance expenses.
Fear factor: 3
Don't worry: Like regular employer plans, Taft-Hartley plans might prove resilient for the simple reason that nobody is looking to change arrangements right away.
Worry: Labor doesn’t have the clout it once did, making it tough to defend these plans in collective bargaining.
Unexpected consequence: With less ability to negotiate on benefits, unions focus more on wages—and workers appreciate them more.
The doctor is in—but can’t see you.
Many of the new insurance exchange plans have limited networks of doctors and hospitals. This isn’t a new phenomenon, but the plans seem to be doing it more aggressively than in the past. There’s a reason: It’s a good way to keep premiums down. And if the plans do it right, they can steer patients to more efficient and higher-quality providers. Obamacare includes standards for “network adequacy,” though it remains to be seen whether those standards do much good.
Fear factor: 2
Don't worry: If the polls are right, most people would put up with fewer provider choices if it means paying less for insurance.
Worry: The people who care about physician and hospital choice are frequently the ones with more severe medical conditions.
If things go badly, don't be surprised if...: Doctors and hospitals make a very big fuss—and then lower their prices.
They call it the “Affordable” Care Act but…
The premiums available on the new exchanges indeed look affordable, despite all that you have read. But a lot of those plans have high cost-sharing. A little noticed study co-authored by MIT economist Jonathan Gruber, an influential Obamacare proponent, suggests some people will struggle with costs—and need more help. They won't be worse off than today, but they won't be better off either. The same goes for dependents of workers whose employers offer coverage that is affordable for a single person, but not the whole family. This is the “affordability glitch” Bill Clinton mentioned as something that needs attention.
Fear factor: 6
Don't worry: The net effect of Obamacare will be to make insurance affordable for many, many more people.
Worry: The people left out are some of the very ones reform is supposed to help.
If things go badly, don't be surprised if...: Democrats push for and win more affordability protections, but only by trading away something they value—and probably not until after the next election.
Your doctor asks about your sex life, posts details on YouTube.
This came from Betsy McCaughey, the woman who brought you death panels. And her argument is only slightly less ridiculous than I just made it sound. She thinks the law penalizes doctors who don’t ask patients about sexual history. The law won’t do that, although—as it happens—asking about sexual history is both routine and recommended, because it’s frequently linked to disease.
Fear factor: Zero
Don't worry: What, you’re going to listen to Betsy McCaughey?
Worry: Actually, don't.
If things go badly, don't be surprised if...: As a show of protest, Tea Partiers refuse to tell their doctors about sexual history—and end up with skyrocketing rates of misdiagnosis.