Expect health glitches, not calamity

Guest Editorial
(Editor’s note: This editorial is reprinted from USA Today, where it was first published.)

Most Americans are at least aware that Obamacare will require almost every citizen to have health insurance, but that starts to get real Tuesday. The mandate doesn’t take effect until January, but anyone who doesn’t already get insurance at work or through government programs such as Medicare and Medicaid will be able to start signing up for private policies under the new law Oct. 1.

Expect trouble. The health exchanges where people will sign up are new, and like anything this big, glitches are inevitable. Exchanges intended to be friendly online stores will be less seamless than Expedia or Amazon, at least at first.

Despite the fact that Obamacare has been law for years, people still don’t know much about the exchanges. Some authorities have withheld public service announcements until people can sign up. Shamefully, many Republican governors and state legislatures have tried to make the law fail by refusing to run exchanges (forcing the feds to step in) or in some cases purposely making it hard for people to find out what their options are.

For all the noise, it’s easy to overestimate the impact of the exchanges. The majority of Americans won’t need them. Of the 232 million nonelderly people projected to have health coverage next year, the Congressional Budget Office forecasts that just 3 percent will buy policies on the exchanges. But it’s also easy to underestimate the importance of the exchanges, since they’ll be the most visible part of the new law and something anyone could need at some point in their lives. This is where people who have been blocked from getting insurance because of pre-existing conditions will be able to get coverage.

Some criticized the exchanges for being unfair and expensive, especially for young people. A quick look shows those criticisms are overblown. Premiums will be higher in some states for some policies, but it’s crucial to make fair comparisons:

• Many pre-Obamacare policies are cheaper because the healthiest people can buy them. Fixing that problem was a major reason for reform.

• Another reason some policies are cheap is that they don’t cover much and cap out at a fixed amount, so a policyholder in serious medical trouble can run out of insurance just when it’s most important. Obamacare sets standards for “essential health benefits” and does away with caps.

• Obamacare limits premiums for older people to no more than three times the charge for the youngest policyholders, which raises costs for healthy people in their 20s and 30s. But low-paid younger people will be eligible for subsidies that lower their premiums.

When the inevitable problems begin turning up, it might be worth remembering the fury that greeted Medicare’s prescription drug program when it introduced exchanges in 2006. Last year, a poll showed that 90 percent of seniors like the program. It is politically unassailable.

Maybe that’s what Obamacare’s critics really fear — that once people realize the nonstop demonization of the new health law has been mostly lies and exaggerations, they might like it.