ACA Exchanges Debut Oct. 1 Amid Uncertainty

September 24, 2013

In This Article

The Affordable Care Act (ACA) promised physicians more insured patients — 30 million-plus over the next decade.

Come Tuesday, October 1, the medical profession and the rest of the country will begin to see whether the law lives up to its great expectations.

On that day, online insurance marketplaces, also known as exchanges, in each of the 50 states and Washington, DC, will open for business. There, adults younger than 65 years and small businesses can shop for a health plan from a private insurer that will come with a premium subsidy for most buyers. Coverage will begin on January 1. The ACA requires most Americans next year to have coverage through a government program or private insurance, or else pay a penalty — the individual-mandate provision that barely survived a Supreme Court challenge in 2012.

Like a salmon swimming up bear-infested rapids, the ACA has faced one peril after another, most of them stemming from staunch Republican efforts to repeal or defund the law since President Barack Obama signed it in March 2010. Case in point: The GOP-controlled House on September 20 passed a bill that funds government operations in the new fiscal year beginning October 1, but strips out spending for the ACA. Promised opposition from the Democrat-controlled Senate and Obama sets the stage for a possible stalemate that could shut down the government on the very day that the ACA exchanges start taking applications.

This ongoing political controversy factors into the question of how many Americans will use the exchanges.

"The defunding efforts foster confusion and uncertainty," said Ian Hill, a senior fellow at the Urban Institute specializing in health policy. "Large proportions of people don't understand what the law will do for them. Some don’t know it is the law of the land."

The Obama administration has added more question marks by delaying 2 provisions of the law until 2015. One is the mandate for large employers to provide insurance coverage to employees or pay a penalty. The other provision limits out-of-pocket costs such as deductibles and copayments for individuals and families.

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