By David Lauter
12:17 PM EST, December 23, 2013
WASHINGTON -- Midnight on Monday is the much-talked-of deadline for Americans to enroll in health plans that will be effective Jan. 1. Here are five key facts to keep in mind.
1. It's a deadline -- sort of.
Monday is the last day to sign up for coverage effective Jan. 1, but it's not the last day to sign up overall. Open enrollment continues through March.
If a person enrolls Thursday, for example, he or she will still get coverage, but it wouldn't begin until February.
Many healthcare experts have predicted for months that a lot of low- and middle-income Americans -- the groups Obamacare primarily aims to help -- wouldn't sign up for health insurance this month because families tend to use whatever spare cash they have this time of year for gifts, not insurance premiums.
2. No one knows whether the total number of Americans with private insurance will go up or down as of Jan. 1.
The new healthcare law will likely result in more people having some form of coverage. The law's expansion of Medicaid pretty well guarantees that.
There's also little doubt that, eventually, Obamacare will increase the number of people with private insurance, because it provides billions of dollars in tax credits to make insurance more affordable for individuals and families. But whether that will happen by Jan. 1 remains unknown.
Why? Several million Americans -- no one has an exact count -- received letters over the last couple of months telling them that their current insurance policies would be canceled because those plans don't meet the standards set by the new law.
Some percentage of people with canceled policies have already purchased new plans. In some states, but not all, insurers have rescinded the cancellations, following a recommendation from President Obama. But no one knows for sure how many policies have been renewed and how many have been replaced. The White House estimates that about 500,000 people whose policies were canceled remain uncovered, but officials concede that the number is fuzzy.
How is it that such basic figures aren't known? The government knows how many people buy insurance through the marketplace exchanges that Obamacare set up. But it has much less information about the number of people buying directly from an insurer outside of an exchange. Those sales get regulated by insurance commissions in each state, and no central data source exists.
3. The administration has made a lot of changes to the Affordable Care Act, but "the core" of the law, as Obama said in his news conference Friday, remains largely unchanged.
To deal with problems in the law, Obama and Health and Human Services Secretary Kathleen Sebelius have extended deadlines, postponed some parts of the law and created exemptions. Opponents say the White House has exceeded its authority and rewritten what Congress approved. Administration lawyers say their actions fall within the traditional discretion that the executive branch gets in putting a big, complex piece of legislation into action.
But for all the law's complexity, its core is pretty simple: Insurers now have to cover everyone, regardless of any "preexisting conditions"; everyone has to get coverage; and the government will subsidize the cost for a significant share of the population -- up to incomes of about $90,000 a year for a family of four.
4. The new law has created winners and losers, and its supporters and foes both have plenty of anecdotes.
The administration and its supporters have lots of examples of Americans who are insured for the first time because of the new law, and others who have insurance at lower cost than before. Opponents of the law have counter-examples of Americans whose premiums have shot upward.
Before Obamacare, the "individual market" -- which mostly covers people who do not get healthcare coverage through their jobs -- worked reasonably well for some. Those in good health could buy coverage at a fairly low cost. Insurers could afford to sell such policies because they could exclude millions of others who had health problems.
Now that insurers can't exclude anyone, some healthy people who bought insurance on the individual market are inevitably going to see their costs go up. The law's requirements that policies cover a broad range of medical conditions will also drive up costs for some people.
Whether that's fair or not is a question that will no doubt be debated over and over during the next several election cycles.
5. We won't know whether Obamacare is "working" for many months -- perhaps years.
Anyone expecting Monday's deadline, or Jan. 1 or even the end of open enrollment to tell us whether the law is succeeding or failing will be disappointed.
The law has two big goals -- to greatly shrink the percentage of people without insurance and to help control healthcare costs.
As noted above, we won't have a true measure of how well that first goal is being met until the end of open enrollment. Even then, we'll only know the impact of the first year. In subsequent years, enrollment could grow a lot if the law's initial problems are overcome -- as happened with the Medicare prescription drug benefit in the George W. Bush administration -- or enrollment could shrink if premiums rise too fast.
As for cost control, healthcare costs have moderated a lot in the last couple of years. Administration officials say the new law deserves part of the credit. The law's critics question that. Some predict that inflation in healthcare costs will resume as the economy improves.
Polls show that Americans have rendered a preliminary -- and predictably polarized -- verdict. About 22% see Obamacare as the president's biggest achievement, while 36% call it his biggest failure, according to a new Gallup poll.
Nevertheless, a final verdict on Obamacare probably won't come during the Obama presidency.
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