Room for Debate (The New York Times), May 29, 2013
The opponents of the Affordable Care Act are on a feeding frenzy, highlighting any evidence of glitches, real or imagined, in the implementation of the bill. The claim that the bill is complex is undoubtedly true. The bill had to be complex to navigate through Congress and appease enough of the powerful interests affected (like drug companies, insurers and doctors) while still extending health care coverage. The result was a bill with several provisions that make little sense and provide perverse incentives to employers and workers.
The Republicans have done everything possible to make the situation worse. At the Congressional level, they have tried to cut off funding for implementation and even harassed the administration over seeking private funding to publicize the provisions of the law.
At the state level, Republican governors and legislators have opted not to set up the state exchanges that are the centerpiece of the bill and have refused federal funding to extend Medicaid coverage. This creates an absurd situation in which many moderate-income families will be able to get federal subsidies through the exchanges while many lower-income families will be denied assistance in getting insurance.
No one can be happy about the inequities created by the health care law. It would have been great if Congress had simply extended the Medicare system to cover the entire population, but this didn’t happen and does not seem likely in the foreseeable future.
When the main provisions of the Affordable Care Act take effect next year, millions more people will have insurance. More important, those of us who are already insured will know that if we lose our jobs because of poor health, we will still be able to afford insurance in the individual market, even with a pre-existing condition.
There will undoubtedly be many glitches. People who are supposed to get subsidies will not, and many families will get larger subsidies than provided in the law. There will also be efforts by companies to game the system.
However, this is not a fatal disaster. Other flawed systems still essentially work: Does anyone believe that every household in the United States pays the right amount of taxes? And the gripes from businesses are overblown: there are few companies that employ close to 50 workers (the cutoff for the insurance requirement) that do not already provide insurance.
The current system is already a Rube Goldberg game, as any employer who provides insurance knows. And it was unraveling before the Affordable Care Act, with employer-provided coverage dropping by more than 12 million from 2000 to 2010.
There will be many who want to celebrate the glitches as implementation proceeds, but serious people will be focused on making the law better so we can effectively provide care at the lowest possible cost.