ADVERTISEMENT

Health care overhaul is complex web

  • Article by: Sheryl Gay Stolberg and Robert Pear
  • New York Times
  • March 27, 2014 - 9:24 PM

 

– The online insurance marketplace in Oregon is such a technological mess that residents have been signing up for health coverage by hand. In Texas, political opposition to President Obama’s health law is so strong that some residents believe, wrongly, that the program is banned in their state.

But in Connecticut, a smoothly functioning website, run by competent managers, has successfully enrolled so many patients that officials are offering to sell their expertise to states like Maryland, which is struggling to sign people up for coverage.

The disparities reveal a stark truth about the Affordable Care Act: With the first open enrollment period set to end Monday, six months after its troubled online exchanges opened for business, the program widely known as Obamacare looks less like a sweeping federal overhaul than a collection of individual ventures playing out unevenly, state to state, in the laboratories of democracy.

Numbers hailed as success

The White House said Thursday that more than 6 million people had signed up for private plans, a significant political milestone for the Obama administration. Independent analysts estimate that an additional 3.5 million Americans are newly insured under Medicaid — figures the law’s backers hail as a success.

But those numbers may not reveal much. Federal officials do not know how many of those who selected plans were previously uninsured, or how many actually paid their premiums. Independent experts warn that the intense focus on national numbers is misguided, and that it will take years to fully assess the law’s impact, much less deem it a success or a failure.

“The whole narrative about Obamacare — ‘Will they get to 6 million? What is the percentage of young adults going to be?’ — has almost nothing to do with whether the law is working or not, whether the premiums are affordable or not, whether people think they are getting a good deal or not,” said Drew Altman, president of the Kaiser Family Foundation, whose analysts are tracking the measure.

“It’s almost like trying to predict the local weather from national averages,” Altman said. “This is really now a state and local game, not a national one.”

Results depend on address

Indeed, a review of state-by-state enrollment data and other research and interviews suggest that, for consumers at least, the state of health care under the national law depends almost entirely on where a person lives.

Some states have had a flowering of competition among insurers, including nonprofit co-ops — entirely new entities that are capturing the largest market share with low prices and remaking the coverage landscape in places like Maine. But in other places, including parts of states like New Hampshire and West Virginia, consumers have hardly any insurance choices at all.

The deep political divisions the law has engendered make assessing it a complex task. The evidence remains largely anecdotal; for every satisfied supporter, it seems, there is a disgruntled opponent.

© 2014 Star Tribune