It’s October 1: Health Exchanges Open, World Doesn’t End

Well, the day has finally come. The Affordable Care Act’s health insurance marketplaces are up and running, ready to sign up millions of Americans shopping for coverage. And as has been the case since the law first began wending its way through Congress, over-heated rhetoric and plain old obstructionism have turned the first day of what will be a long, gradual process, into a highly-charged circus.

With House Republicans refusing to approve financing for government operations unless “Obamacare” is delayed or defunded, the federal government is closed for business; 800,000 workers are on furlough, national parks are closed, the National Zoo’s panda project has stopped providing live feed, tax audits grind to a halt and a range of other non-essential services will cease. And for what? The nation is being held hostage by hardline conservatives who refuse to accept a law that was enacted by Congress, backed by the Supreme Court and promises to offer affordable health coverage for millions of uninsured, low and moderate-income Americans.

The truth is, the health law will move forward despite the theater unfolding right now. Granted, the ACA is complicated, balky and yes, imperfect legislation that will need tweaking as the major provisions are implemented. But guess what doomsayers? The world did not come to an end when “Obamacare” opened for business today. In fact, for the 88% or so of Americans who already have health coverage from their employers, Medicare or Medicaid, there is zero impact. For those of us who hope to buy insurance through the exchanges or will now be covered by an expanded Medicaid program, we have until the end of March 2014 to sign up for individual or family coverage.

That’s not to say that the roll-out will go smoothly. The ACA marks the first new national social insurance program since Medicare and Medicaid were signed into law in 1965. The federal government is running insurance exchanges in 34 states while 16 others have set up their own marketplaces using federal money from the health law. It’s a massive undertaking and a vast public-private venture without precedent.

Questions remain about the affordability of premiums, breadth of provider networks and whether the exchanges can attract enough young, healthy “invincibles” to offset the cost of covering older, sicker people with pre-existing conditions. In the New Republic, Jonathan Cohn ranks and offers cogent insight into possible Obamacare glitches (website crashes, part-time workers losing hours, unaffordable premiums) you will be hearing about in days to come.  His take-away: Most of these concerns are overrated and  “It will be months, at least, before we have a real sense of how well Obamacare is working. ”

At a press briefing yesterday, Health and Human Services Secretary Kathleen Sebelius also acknowledged that glitches will inevitably arise in coming weeks and months. According to Kaiser Health News , “the Spanish version of the website and the exchange for small employers have been delayed several weeks. ‘We know opponents are desperate for anything that could go wrong,’ Sebelius said noting that she hoped the public would give the administration time to work out the kinks the same way it does when Apple has to upgrade its software. She also pleaded with reporters not to make final judgments on the exchanges after one week.”

Still, the benefits of expanding coverage will remain clear. The Congressional Budget Office projects that 14 million uninsured Americans will gain coverage in the first year of implementation and about 25 million people are expected to obtain insurance through the exchanges or Medicaid expansion by 2023. . Roughly 48 million Americans are currently uninsured, according to the Census Bureau.

As Congress continues its dysfunctional budget negotiations and hysteria about the debt-limit deadline intensifies, health reform chugs on. With funding in place, exchanges open for enrollment, and the individual mandate set to go into effect on January 1, the most serious challenges to implementation may be public awareness and perception. A recent Commonwealth Fund survey finds that although more than three-quarters (76%) of adults know they are required to have health insurance next year, only two of five are aware of the new marketplaces or that they will be able to apply for financial help.

Opponents of the health law are capitalizing on this knowledge gap and filling the void with scare tactics and misinformation. In recent weeks the Heritage Foundation erected a huge billboard  over New York City’s Times Square that resembles a tobacco disclaimer with the text “WARNING: Obamacare may be hazardous to you health.” Revolting “creepy Uncle Sam” videos aimed at scaring 20-somethings have gone viral on YouTube and carry the catch phrase, “Don’t let government play doctor.” John Boehner tells us in a press conference, “It’s time to protect American families from this unworkable law.” Protect, indeed.

Sebelius told reporters that she is not surprised that many Americans are still confused about the health law and are still unaware of many of its benefits. She noted that political opponents have spent $400 million on negative ads compared to $75 million in ads supporting the law.

But at the end of this historic day here’s the reality. Today’s opening of the insurance exchanges was encouraging—President Obama said that more than a million people visited healthcare.gov (the marketplace for the federally-run exchanges) by 7AM—despite scattered reports of long wait times and slow systems. In New York, state health officials reported that the exchange website had over 2 million visitors in just the first hour and a half it was open. Perhaps the media build-up to the federal government shutdown had the unintended result of getting more Americans to focus on trying to understand Obamacare. Maybe they aren’t buying the doom and gloom predictions of opponents who would risk the nation’s economic health to get the ACA delayed or repealed. Maybe they see that the real hazard to Americans comes from political bullies who will stop at nothing to get their way. And maybe we can dial back the rhetoric a bit and let the slow process of health reform and implementation continue.