Friday, June 6, 2014

ObamaCare’s Strange Summer Interlude

Strange interlude! Yes, our lives are merely strange dark interludes.

Eugene O’Neil, (1888-1953),  Strange Interlude (1928)

A strange ObamaCare interlude is upon us.

We are in an interim period between figuring out what occurred with the first launch (October 1913 to March 2014) and the second launch (November 2014 – May 2015).   Just before the second launch we shall have the November midterm elections, which could change everything. 

During the interlude,  we will witness a series of events, and  of which could change the election outcome.

·         Vigorous and sometime vitriolic GOP anti-ObamaCare campaigning.

·         A  strange combination of Democratic retreat from ObamaCare by vulnerable Democrats in Red States and doubling down on ObamaCare by Democrats with safe seats in Blue states.

·         A watchful eye and political focus on how to react when health plans announce double digit premium and deductible hikes in some but not all states.

·         A continuing reassessment by major players – physicians, consumers,  hospitals, health care companies, unions, health plans, and pharmaceutical companies and device manufactures  - as the campaign wears on from now to November.

·         More confusion with conflicting conclusions  of whether lowered costs and the number of uninsured,  increased access, or merely demonstrated government incompetence in launching vast IT projects with half-vast oversight.

·         How much government and taxpayers will have to pay to “bail out” health plans because of ObamaCare shifting ad hoc approach to changing mandates and health law provisions. 

·         Whether a sufficient number of physicians will accept ObamaCare  health plans without generating endless waiting lines, what to do if employers dump workers onto the exchanges,  and if there are enough primary care for the 6 million more Medicaid recipients.

How will physicians react to this chain of events?  No one knows for sure, including physicians themselves.   Physicians are as autonomous as ever,     and they have no national political organization representing enough of them to lead them out of the ObamaCare wilderness during the summer interlude.  

Physicians tend to believe that consumers and patients, given choice of doctors and hospitals,  provided with transparent and understandable information on price and outcomes,  and assured of direct quick access to private physicians without intervening government and insurer bureaucracies, will choose direct pay for physicians  to increasingly  unaffordable premiums and deductibles.     

But this belief is untested on a grand scale.   Other players in the health care industry  - government policy makers, insurer and hospital executives, and drug and device manufactuers – are not sure what will happen. They are not confident consumers know enough to make the right decisions.   Nor are they convinced doctors will act in the consumers’ best interest or in their own self-interest.

The U.S. is between Act One, the first ObamaCare launch, from October 1, 2013  to March 28, 2014, and the second launch, November 15, 2014, to sometime in May, 2015,  which will follow the November 4 midterm elections.   This 5 month interlude period  will be highly political, and as every politician knows,  5 months is a lifetime during which anything can happen and probably will. 

It there an single thing that might occur during the interlude that might derail ObamaCare?   

Yes, it might be failing to fix  The fix is underway to get the website ready for November 15, but it is behind schedule.  Does government have the competency to fix its glitches, to replace that separate hardware that people use to create accounts and log in to, which locked so many visitors out?    Can it integrate the federal and state exchanges? Can it work its way through that backlog of 2.2 million consumers whose applications contained errors but were rewarded subsidies anyway? Will its various fixes speed access or just create more confusion among insurers and consumers? IT contractors and Republicans are skeptical these questions can be answered and these problems can be resolved, before the next open enrollment.

Tweet:  The U.S. health reform effort is in a strange interlude between the first and second healthcare .gov launch.  Health reform’s future will depend on the outcome of November midterm elections.

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