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Slow start expected for system

The Washington Post

The White House is downplaying expectations for the first day of the Affordable Care Act’s insurance marketplaces.

In recent weeks, senior administration members have begun predicting that there will be relatively few takers on Tuesday, when tens of millions of Americans will, for the first time, be able to sign up for new insurance options. That means the date, which has long been circled on health-policy calendars in the administration and across the country, actually represents a “soft launch.”

“October will be light for enrollment,” White House Deputy Senior Adviser David Simas said. “Some people will sign up. November will be a little better. December, when people can sign up and know they get coverage in a week or two weeks, will be better than the previous month.”

In the House of Representatives, a vote Saturday all but guaranteed the government will shut down at midnight Monday, just as the Affordable Care Act’s marketplaces, known as exchanges, get ready to open for business Tuesday. But President Barack Obama has made clear that the exchanges will open, no matter what.

House Republicans insisted that delaying implementation of the health law was far more reasonable than an earlier demand to defund the law entirely. After all, they said, Obama has delayed numerous provisions of the law for unions, big business and other special interests; why not do the same for the American people?

Most Americans remain largely unaware of the health care law’s marketplaces, with polls showing many have no idea when enrollment begins — or if the Affordable Care Act is even still law. Technical glitches have delayed some pieces of the marketplaces, meaning the first wave of shoppers will likely have the bumpiest experience.

That has some officials working on the health law cautioning against setting expectations too high for the health law’s debut. The president, for example, often compares shopping for health coverage on the marketplaces to buying a plane ticket on Travelocity or Expedia.

The actual experience, according to those setting up the law in the states, is likely to be more complex, and almost certainly will take longer than a few minutes.

“I think as a metaphor it’s good, since it anchors the idea of cost competition in people’s minds,” said Kevin Counihan, executive director of Health Access CT. “The reality is that picking a plane ticket is different than selecting a health plan.”

White House officials say low enrollment in October would not reflect negatively on the law. They point to Massachusetts, which had an initially slow uptake rate but a big spike in November 2007, the month before a mandate to buy health insurance coverage took effect.

Officials who worked on the Massachusetts insurance expansion say that, in their experience, shoppers had an average of 18 encounters with the online marketplaces before purchasing coverage.

Under Obama’s law, the requirement to carry health coverage does not take effect until January. Any insurance plans purchased this fall do not take effect until the start of 2014. Officials in Washington and across the country are skeptical that many people will buy a product in October that does not begin covering them until three months later.

“The idea that people are going to do layaway purchasing three months out goes against the American way,” said Christine Ferguson, Rhode Island’s exchange director.

Open enrollment lasts until the end of March, giving the uninsured a six-month period in which to purchase coverage.

“We are looking at Oct. 1 not as the beginning of a six-day or six-week push,” Simas said. “This is six months of raising awareness, seeing what we can learn and applying that.”