By the most convoluted methods -- and narrowest of margins --
the U.S. Supreme Court approved the Patient Protection and
Affordable Care Act (ACA), which the president is happy to now call
Republicans will fight and the Tea Party will rail against the
way Chief Justice John Roberts did an end run around his
conservative colleagues and turned the "penalty" into a "tax." But
it is law for the foreseeable future. "The health care reform genie
is out of the bottle and there is no way to get it back in," says
Lawrence Mirel of R Street, a Washington, D.C.-based think
The result: Millions of Americans may have to seek their own
and purchase it through newly formed health insurance exchanges,
which must be operational in all 50 states and the District of
Columbia by Jan. 1, 2014. These exchanges, arguably the most
important part of the law, will be Internet marketplaces where
health insurance companies will compete for the consumer's dollar
and he or she will, hopefully, get the best deal.
An estimated 134 million Americans with full-time employment
have health coverage through their companies. But about two-thirds
of those firms could decide that, under Obamacare, their premiums
are too expensive, according to a study by
insurance broker Willis Group
. Kevin McCarty, Florida insurance commissioner and president of
the National Association of Insurance Commissioners, is among those
who are "concerned about the potential for increased health
insurance premiums and continued disruption to the stability of the
marketplace" as a result of the ACA.
For companies that want to drop their own health insurance
plans, the ACA offers an easy out: Pay a $2,000 penalty per
employee. That's far less than the $10,000 average cost of a health
care plan. And that's particularly true if you are a low-income or
part-time worker at a company like McDonald's or Walmart that
doesn't need to offer a Cadillac health plan to keep employees.
President Obama is well aware that this new law has
fundamentally changed the health care industry and that people are
going to need an alternate way to obtain the mandated insurance
The Department of Health and Human Services has already sunk $1
billion into grants to set up the new health insurance exchanges
and a federal health exchange in states which hold out. Governors
like New Jersey's Chris Christie and Wisconsin's Scott Walker, who
fought against the exchanges or refused to move ahead, will have to
speed up the process to meet the January 2014 deadline, or have it
done for them by the federal government.
To date, 14 states and the District of Columbia have already
established health insurance exchanges, according to the Kaiser
Family Foundation, including California, Massachusetts and New
York. Three states -- Louisiana, Maine and New Hampshire -- have
refused. Other states are "studying options," or have had "no
An educated consumer
Since health exchanges and other major parts of the ACA don't
become law until 2014, and because companies are still considering
their options, most people have some breathing room.
If employed with a health care plan, employees should keep a
close eye on which way their company is leaning. Will your employer
indicate it will drop its plan or raise the costs of the plan to
the point where it becomes unaffordable for workers? Will it offer
financial incentives to employees to leave the plan and go to the
health insurance exchange instead?
For the 27.5 million self-employed Americans who run a small
business, or the 30 million who don't have health insurance, the
best choice might be to go to the health exchanges once they are
operational. Theoretically, all major health insurance companies
within a state will participate, as they do in Massachusetts. New
initiatives may allow out-of-state insurers to compete, thereby
lowering costs even further.
Click and buy
The best window into how a health insurance exchange will
operate can be found in Massachusetts, where
"The Health Connector,
" started under former governor and now Republican presidential
candidate Mitt Romney, has been operating since 2006. Its website
features options from eight different insurers, and consumers
"click and buy" the same way they would with any other website.
Right now, 98.1 percent of Massachusetts residents have health
insurance, according to Connector spokesperson Richard Power, and
227,000 purchase it through the state's health exchange.
But will average Americans be able to wind their way through the
complex health care maze -- an issue so complicated that it led to
a confusing 2,400-page law and a 250-page Supreme Court decision?
That remains to be seen.