For many patients, health care providers, hospitals and other health care organizations, the potential fallout from this element of the Affordable Care Act may seem like the proverbial end of the world. At the very least, there will be changes in the provision of, and reimbursement for, medical care that many will not like.
The health exchange shell game will become obvious to families of four with incomes above $100,000. They will not qualify for federal subsidies and will pay about $10,000 annually for “silver” insurance plans (“gold” and “platinum” are extra). Their contributions in premiums and taxes will be much appreciated by families less financially well-off who will get similar coverage at much lower cost.
But it gets even better. There probably will not be enough boots on the ground to handle the anticipated onslaught of health exchange applicants, many of whom are unable to enroll online. Consequently, means testing may not be enforceable and families, otherwise financially ineligible for discounts, still may be able to game the system to their advantage.
In something that resembles a crisis mode, the administration will pull out the stops to sell the ACA using public service announcements and personal appeals by – are you ready? – Bill Clinton, among others. What should anger many Americans is that although this legislation was passed three years ago, the health care sector of government has kept many of its more specific elements under wraps for so long.
While I disagree with the Republicans’ shut-down-the-government game of chicken, I do agree that there needs to be a bipartisan dialogue on how best to proceed with the ACA ingredients that can be feasibly implemented now, and shelving those that are too costly for the U.S. economy. Simply taking the “my way or the highway” approach of both parties (and the administration) will never solve such large and thorny problems.
Perhaps it is time to exhume the late Henry Clay, “the Great Compromiser,” and have his conciliatory skills broker the deal that would best serve our country.