The following column was published on May 29th, 2013 in the New York Times’ Room for Debate blog, which asked the question, “Is Obamacare too complicated to succeed?”
Is the Affordable Care Act complicated? Of course it is. Even one of its architects concedes that it is phenomenally complex. Why? To pass, it had to be contorted to satisfy a number of special interest groups.
As its major reforms are implemented in 2014, even supporters of Obamacare warn of a rough start. Three of the big obstacles:
1. Those without employer-sponsored health insurance will be required to purchase plans through health exchanges. The vast electronic infrastructure needed to power these exchanges has to be built from scratch, and in many states may not be ready in time. The exchanges’ insurance products could also be expensive, if not enough healthy people sign up. And the method for individuals to apply for these benefits is laughably complex, with the draft application form initially spanning 21 pages.
2. More than 30 million newly insured patients will be looking for health providers, only to be faced with long waiting lists. There is a shortage of more than 13,000 physicians, which is expected to grow to 130,000 by 2025, according to the Association of American Medical Colleges. Even by expanding the scope of practice of nonphysician providers, like nurse practitioners, it won’t be enough to meet the primary care demand that Obamacare brings.
3. Some states are still debating whether to expand Medicaid. If they decline, millions of poor Americans would remain without health insurance.
Despite the challenges, there have already been incremental advances with Obamacare. The law has significantly increased the health coverage of young adults. And recent data has shown that health costs have slowed, mostly because of the economic downturn but partly because of provisions in the Affordable Care Act.
And consider two successful health programs that also started poorly. The Children’s Health Insurance Program enrolled only 897,000 kids in the first year of operation, but expanded to four million children within five years. Medicare’s prescription drug benefit (Part D) had significant administrative difficulties when it first began, but once those were corrected, it has since run relatively smoothly.
Besides, compare Obamacare to the alternative, which would be no health reform at all. Almost 50 million Americans would remain without health insurance. And costs would continue to rise from what Americans spend today on health care: 18 cents out of every dollar.
Improving on those numbers is a very low bar to clear. Despite Obamacare’s complexity and the rocky implementation expected, its very existence is a success.
