Obamacare Arrives

Kliff heralds the dawn of the Obamacare era:

The next Obamacare fight is going to be about access. After three months of enrollment, January will be the first month when shoppers can see what they purchased. We know that the plans for sale on the marketplace tend to have relatively limited networks, as insurers restricted doctor access to hold down premium prices. New subscribers could find that a doctor they want isn’t in network, and get frustrated. Co-payments may seem alarmingly high — a byproduct of keeping premiums low. While the health-care system probably has the capacity to absorb a few million new insurance subscribers … there is still room for issues about access to specific doctors and the price tag that comes along with trips to the doctor’s office.

Kate Pickert also focuses on limited networks:

A recent study suggests limited provider networks could become more common in the years ahead as the ACA takes hold. A Dec. 13 McKinsey study of 20 U.S. metropolitan areas found that two-thirds of ACA plans analyzed had “narrow” or “ultra narrow” networks, with at least 30 percent of top 20 hospitals excluded for coverage. The medium premium for plans with narrower networks, according to the study, was 26 percent lower than comparable benefit packages with broad networks.

Cohn asked various health care wonks to make predictions about how the ACA will fare this year. Here’s Sean Parnell, author of The Self-Pay Patient, who is among the more pessimistic:

The biggest hurdle will be enrollment, particularly among the young and healthy. Deductibles are high, premium subsidies generally aren’t available except to the poorest, the tax for being uninsured is low, and the young have always been overrepresented among the uninsured. This will continue to be the case in 2014 and beyond.

Late in 2014, insurers will announce premiums for 2015. They will be higher, inflicting a political price on Democrats. Expect more creative interpretations and regulatory flexibility out of the Obama administration in order to smooth over more unintended consequences of the ACA.

There will be more Americans who pay directly for more of their health care. The ACA is projected by the Congressional Budget Office to leave 30 million people uninsured, and tens of millions more will get high-deductible plans through exchanges or their employers. These self-pay patients will demand price transparency and discounts for paying in full at the time of treatment, and innovative entrepreneurs will step up to cater to them while ignoring the traditional third-party payment system.

At the end of 2014, I expect to see many advocates of the ACA look back and conclude that while it’s too early to call the law a failure, the meager results fall far short of what was hoped for.