WASHINGTON (AP) — Its place assured alongside Medicare and Medicaid, President Barack Obama’s health care law is now in a sprint to the finish line, with just 11 months to go before millions of uninsured people can start signing up for coverage.
But there are hurdles in the way.
Republican governors who derided “Obamacare” will now have to decide whether they somehow can join the team. And the administration could stumble under the sheer strain of carrying out the complex legislation, or get tripped up if budget talks with Congress lead to scaling back the plan.
“The clarity brought about by the election is critical,” said Andrew Hyman of the nonpartisan Robert Wood Johnson Foundation. “We are still going to be struggling through the politics, and there are important policy hurdles and logistical challenges. But we are on a very positive trajectory.” Hyman oversees efforts to help states carry out the law.
In the two years since passage of the Affordable Care Act, the Obama administration has been consumed with planning and playing political defense. Now it must execute.
States must notify Washington a week from Friday whether they will be setting up new health insurance markets, called exchanges, in which millions of households and small businesses will shop for private coverage. The Health and Human Services Department will run the exchanges in states that aren’t ready or willing.
Open enrollment for exchange plans is scheduled to start Oct. 1, 2013, and coverage will be effective Jan. 1, 2014.
In all, more than 30 million uninsured people are expected to gain coverage under the law. About half will get private insurance through the exchanges, with most receiving government help to pay premiums.
The rest, mainly low-income adults without children at home, will be covered through an expansion of Medicaid. While the federal government will pay virtually all the additional Medicaid costs, the Supreme Court gave states the leeway to opt out of the expansion. That gives states more leverage but also adds to the uncertainty over how the law will be carried out.
GOP governors are pressing HHS Secretary Kathleen Sebelius on whether the administration will approve partial, less costly Medicaid expansions. There has been no ruling yet.