ted-cruz-and-stafferWatching the government-shutdown fracas this month has been both surreal and painful for me.  “Defund Obamacare,” the primary demand of those who orchestrated the shutdown (like Texas senator Ted Cruz, left), feels personal. The law they’re decrying—the Patient Protection and Affordable Care Act—has already been a godsend for some of us.

When I last wrote for WVFC about the Affordable Care Act  (ACA), long before the Supreme Court declared the law constitutional and three years before it was scheduled to take effect, I called it “a sort of Rube Goldberg contraption,”  meaning a machine that uses incredibly complicated gears to accomplish something simple. The law, passed at the end of 2010 and  cleared by the Supreme Court two years later, is due to take full effect this January.

But a few parts kicked in early, most famously the part allowing kids to stay on their parents’ plans till they are 26. And a temporary “high-risk pool” was established for people with pre-existing conditions, to tide us over until insurance companies could no longer treat us differently. I write “us” because I’ve lived with multiple sclerosis for nearly 30 years, and that “high-risk pool” was a lifesaver.

By 2010, I was one of “the uninsured.” A now-freelance writer/editor diagnosed at 22, I’d managed to maintain coverage with a mix of jobs and post-employment COBRA plans; when the latter ran out three years ago, insurance brokers laughed in my face or quoted impossible premium costs. Then I was able to join ACA’s Pre-Existing Conditions Insurance Plan, which enabled me to minimize the disabling effects of my illness, in partnership with top neurologists and physical-therapy pros. All of that was before I broke my ankle two months ago. The surgery the latter required, and the therapy that’s enabling me to come back,  would have been near-impossible for me to obtain without coverage. But this “high-risk pool” really was temporary; it expires in January, and I’ll be back in a private insurance plan, this time via Obamacare’s healthcare exchanges.

You might not have needed to follow the ACA’s gradual rollout since then, though many of us noticed that suddenly we had no co-pays for preventive care; that young people in our lives were getting to stay on their parents’ insurance longer. If you had individual insurance, you might have been startled into awareness by a check from your insurance company because it had spent too much that was unrelated to healthcare. Or perhaps you know someone with diabetes who was suddenly offered a low-cost pedicure, one of the many strategies employed by the new “accountable-care” systems encouraged by ACA.

But even this year, there hasn’t been some  glitzy ad campaign explaining those changes and pumping the new health exchanges. Most people got their image of the new law from the toxic cable news. Little wonder that Jimmy Kimmel could find people who knew only that they hated “Obamacare.”

Cindy Pearson, director of the National Women’s Health Network, has a women’s FAQ on the law at Ms. magazine. Starting now, she notes, women can NOT be charged more than men for insurance under the law and that “All policies have to be comprehensive (which means some of those employer-provided policies are going to get better, too.)”

Uninsured people, while skeptical that the plan would work, told The New York Times  last week that they were hopeful. “Perhaps most tellingly, and a predictor of the heavy traffic that has been reported on the state and federal health care exchange Web sites, the recent Times/CBS Poll found that although those without insurance were divided over their approval of the health care law over all, nearly 7 in 10 of uninsured people said they wanted the health care law upheld and made to work.”

Author and educator John Green agreed, after simultaneously submitting Web queries at healthcare.gov and one for more traditional insurance. The latter took twice as long, and involved queries about whether anyone in his family had needed medical care in the last 10 years.

Green’s video includes the much-reported “glitches” in the government’s Web portal for the exchanges, HealthCare.gov. It crashed repeatedly in the first week.  Even when it’s working, it feels more like waiting for the cable guy than Amazon.com. I know; my dauntless wife has been slowly getting us into the system as a family, and we haven’t got near to picking a plan yet.

A whole ‘nother article could be written about the site, whose code makes computer folks laugh and which, despite the administration’s famed digital savvy, was created by defense contractors with nonspecific expertise. USAToday  laid out the challenges: “The most important is whether HealthCare.gov meets its fundamental task—creating a marketplace with an array of choices and competitive prices. The other [challenge] is whether it explains insurance so people understand it—how to buy it, why they should, how the law’s subsidies work, and helps them start grasping which policy works for them. On those counts, HealthCare.gov is an out-of-the-box success.”

I’d tend to agree on those basics. And if you live in a state that agreed early to participate, you could be enrolled by now. But if you don’t, you’re like me in Philly or John Green, in the video above, who’s from Indiana, and the system is still figuring out how exactly to get us in. “The website is being used in Pennsylvania and 35 other states that decided to let the federal government handle the task rather than do it themselves,”reports the Pittsburgh Tribune. States that set up their own online marketplaces seem to be faring better. The State of New York announced on Tuesday that more than 40,000 of its residents have signed up.”

That Rube Goldberg machine was envisioned with all states doing the same thing, Mother Jones explains.  “The drafters of the ACA never envisioned the federal government running health care marketplaces for most of the country. The ACA was specifically designed to respect the state’s rights that Republicans claim to care so much about. It empowered states, which already regulate the sale of insurance, to run the exchanges. Healthcare.gov was supposed to be a backstop for states either too small to run their own or that dropped the ball on setting up their own exchanges . . . . [But]  instead of running a marketplace for a couple of states as planned, Healthcare.gov is having to do the work of 70 percent of them, including big states like Florida, Texas and Virginia . . .”

Those bigger states are an even bigger mess. “Anecdotal evidence across Florida, which has 3.5 million uninsured residents, the second highest in the country, indicated that few Floridians managed to enroll,” writes The New York Times‘s Lizette Alvarez. “Those who pushed past the pleas for patience often did so in the evening or early in the morning—when Web site traffic is down.”

Enough with the technical difficulties. What else do we need to know, as the law takes full effect?

If you’re already covered by your employer, or if you’re on Medicare, you don’t need to go to that Web portal at all, and you may not see much change except for  free preventive care (already in effect) and better Medicare drug coverage.

If you do need to buy individual insurance, as of October 1 insurers are no longer allowed to discriminate against you for being female or for your medical history. That includes me, along with the  other 110,000+ folks also enrolled in interim plans like mine:  I’ve already started getting mail from mine about the transition to the new exchanges, which is why my wife, a Linux system administrator with mad skills , has already got us pre-registered as a family. We know we have till December 15 to enroll in the plan of our choice, though we don’t plan to tarry.  I’m hoping that enough younger, healthier people will want to join up as well, to make it all work. As I wrote two-plus years ago, to cover those of us who need care “you pretty much need everyone in  common insurance pools, which then leads to the mandate that everyone hates and the subsidies that some find suspect.” With those subsidies, my wife and I can afford this insurance.

I feel lucky: we still have enough income to afford to buy insurance at all.  And I feel a bit guilty for being able to squeeze into the system, especially since I live in Pennsylvania—which like many of the non-participating states, has refused funds to expand Medicaid to cover the working poor. The Medicaid expansion was a kinda-weird  part of the Rube Goldberg assemblage, and what’s left in states like mine is a huge injustice against millions of the people most in need of this law.  

Many of those losing out are people of color.  Atlantic writer Ta-Nehisi Coates rightly calls this immoral: “It is a shock to the entire system, the entire network of black people who— because of white supremacy—live segregated lives, and must bear this on their own.”  It should also be a shock to the nation’s conscience.

The newest reports are that “ending Obamacare” is no longer one of the demands of those who shut down the government. That demand had at its heart a resistance to the idea of the commons, which I suspect is the point and at the root of the shutdown itself.  But I’ll leave any further speculation to the political gurus, as they sort out what’s likely to happen next. For now, at least, I can welcome you to  “Obamacare,” and end with an explanatory cartoon from Kaiser Health News.


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  • Suzanne Fluhr (Boomeresque) October 18, 2013 at 5:01 pm

    The Feds need to do for the program as a whole what Massachusetts did when they rolled out “Romneycare”. Get well known, charismatic people to do PSA’s and promote it in social media. (It’s too bad the GOP frightened the NFL from participating by threats of retaliatory actions against the league).

  • Roz Warren October 18, 2013 at 3:23 pm

    What Janet said. Terrific. Readable. Informative. Moving. I’m sharing it this minute.

  • diane October 17, 2013 at 9:10 pm

    Thrilled that “Obamacare” is now a reality for the millions of people like Chris who otherwise could not afford basic health care now that the current wild west shoot out in Washington has ended. Let’s hope that the people who vote in this country really paid attention to the weeks of wasted time and money over this political fight.

  • Julia Kay October 16, 2013 at 12:16 am

    Excellent, clarifying overview.

  • Chris Lombardi October 15, 2013 at 12:24 pm

    Thanks a lot, Janet. From someone with your expertise, that means a lot.

  • jgolden08 October 15, 2013 at 9:22 am

    Excellent explanation of what the ACA really means. This article should be widely shared.