What needs to happen for Obamacare to survive 2014

7:30 am by | 7 Comments

healthcare.govThe Affordable Care Act is a law intended to help the sick get the healthcare they need at a reasonable cost. But, as we’ve heard time and time again, the law itself is ailing. Some pundits have said the law will most certainly be repealed in 2014, while others cling to the theoretical good it may be doing for some Americans. More still swim through dates and deadlines, wondering when (or if) they need coverage and what kind and whether they’ll be able to keep their doctors and plans.

The ACA has had a rough rollout, by all accounts.  Very little Obamacare news has been good news. Here are six things that need to happen for Obamacare to survive 2014 and potentially thrive without a major operation, a defibrillator or an oxygen tank.

1) Seven million consumers by March 31, 2014.

The Republicans have said 7 million must be reached for the markets to succeed. The White House has said 7 million is just a number filled with optimism. Both are wrong at this point.

To the Republicans’ point, the actual number 7 million has very little (if anything) to do with whether the marketplaces will bear their own weight. The ratios of who is in each market (more on that later) are much more important than how many. An overstatement that illustrates this point:

“I don’t know why they embraced 7 million people,” one insurance industry insider told Politico. “It was just another opportunity to disappoint people. Five million of a good mix is way better than 7 million old, sick people.”

The reason why is because this is the number the Congressional Budget Office laid at the administration’s feet. It gave a tangible goal to complicated legislation. HHS Secretary Kathleen Sebelius herself used the number in defining the program’s success.

This is why the White House is wrong, too. At this point, it’s not just the markets that need to work. The public’s faith in the Affordable Care Act needs serious rekindling (as in, “Grab the lighter fluid!” levels of rekindling).

For the sake of the rollout meeting one major goal, 7 million is a number that must be hit.

The Wall Street Journal reports WellPoint plans to spend $100 million on an ad campaign targeting Young Invincibles by the end of 2013, and TVB estimates insurers will spend $500 million on TV ads for the exchanges in 2014. This could contribute to a surge in the number of enrollees.

2) And of those 7 million, Young Invincibles better show up.

BrobamacareYou’ve heard it time and time again: Healthy young enrollees make Obamacare work (more specifically, they level the health insurance exchanges marketplace to pay for the older, sicker enrollees). If the number’s 7 million, more than 2.5 million, or more than a third, need to be Young Invincibles.

If the 7 million mile mark isn’t passed, that ratio still needs to hold true for the premiums to stay down. And not just in the federal exchanges. In every state. (Even though now it seems even the ratio bar is being lowered.)

But for that goal to be reached, the White House team should nix its current waterlogged, dumbed-down campaign strategies and think up something substantive. More on why the bro-filled ads and Jennifer Hudson sleuth videos aren’t cutting the mustard with Millenials like me or my colleague Deanna here.

3) States with Medicaid expansion need to do better than those without the expansion.

The disparity the coverage gap causes in states that have chosen not to expand Medicaid is frightening. In those 23 states combined, 4.6 million uninsured who fall under the federal poverty line will be too poor to receive aid under Obamacare and too rich (sigh) to receive Medicaid.

Figure 1: In states that do not expand Medicaid under the ACA, there will be a gap in coverage available for adults.

But it is likely those states will blame the legislation rather than the states themselves for this gap. (Wrong-minded, sure, but that hasn’t stopped voters for centuries.)

This means the states that have chosen to expand Medicaid need to fly. My homestate of Kentucky, which is implementing the Medicaid expansion in 2014, is soaring. Never before its health insurance marketplace have I witnessed Kentucky being touted so as a media darling in a context that did not involve an orange ball, fast horses or George Clooney. While I would like to say the best state in our country could hold a national program together, it’s going to take this level of success from each state that implements the expansion next year.

It doesn’t matter if Medicaid actually has anything to do with a particular problem. The states with the expansions will be the ones thrown into the fire. The success stories need to overshadow the negative press.

Which leads me to my next point.

4) No more missed deadlines. No more retreating.

With the deadlines for getting covered by Jan. 1 now muddled due in large part to The Glitchy Website That Shall Not Be Named, the sad attempt at promising the unpromise-able and the delay of the employer mandate, the ACA is less than a tenth of a second from a plain ole shot-clock violation. (FYI: You can sign up until Dec. 23 to get coverage beginning Jan. 1. You need some sort of health insurance by March 31 if you don’t want to be penalized.)

Effective Jan. 1, 2014, there can be no more delays, no more missed deadlines. The hefty law needs to gather its weight and get moving to create serious momentum to push it into 2015.

5) The website needs to be passable. Not fantastic, just one that works consistently. We shouldn’t ever hear about it again after Jan. 31.

Former Microsoft Office President Kurt DelBene will join Jeff Zients in scurrying to fix The Glitchy Website That Shall Not Be Named. Zients’ will be appointed as the White House’s chief economic advisor in February.

Things like this cannot keep happening.

After Jan. 31 (and all those New Year’s reels sure to be filled with the “Obamacare girl’s” face), the ACA’s proponents should avoid talking about the website again at all costs. Move on to the real stats, talking about state ratios and who the bill is helping. Keep the emphasis on an unsuccessful tech launch and no one will remember how the bill works, only that the website didn’t.

6) President Barack Obama needs his base to stay galvanized, and well, just to stay.

Finally, President Obama needs to find a way to protect the Democrats during the mid-term elections, shielding them from any Obamacare blowback. (Was it only two months ago some Republicans feared the repercussions of another GOP-led government shutdown while Democrats made snide asides?) Losing core supporters likely would spell M-A-N-D-A-T-E to the repeal-hungry, even if there are only small losses in small districts, even if that mandate is weak and not nearly resounding.

The setbacks, the glitches and lie, the judicial issues and problems the ACA has faced will put some seats up for grabs. If Obamacare has a survival instinct, the White House will have to fight for these incumbents with all its might. (I anticipate the POTUS Traveling Roadshow will have more episodes than usual this spring.)


I’m of a mind that says Obamacare’s survival is possible and probable. The answer yet to be seen is whether the law’s existence, in piecemeal, part and parcel, will be meaningful, will remain more a policy than a 2,000-plus page tome saying Americans mostly agree universal healthcare might be nice.

Meanwhile, as Dan Munro points out, we’re still arguing over who gets covered without tackling cost.

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Lindsey Alexander

By Lindsey Alexander

Lindsey Alexander is an Indiana-based freelance writer and editor covering the medical device industry. She earned a degree in journalism from Indiana University and a master's from Purdue.
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Success of implementations will continue to be the most significant measurement of the PPACA. Will be interesting to see how well deliverables are met in the coming years.


My fabvorite contemporary philosopher, Ringo Star famously said it all. "Everything the government touches turns to crap." It is the reverse of the Midas touch ... instead of gold you get dung. Your assessments of an Obamcare reboot are beyond optimistic, if not borderline delusional. "Obamascarce' has shown it's real face, which is reosurce disitribution disgusied as a medical plan. Young millenials are not that stupid to sign up en-masse for an overpriced, fiat-soused, and scammy re-insurance sheme. Meawhile too many needy American Boomer's have spent the mother-load of their own biological health-reserves from a lifetime of bad choices. Regardess of the nauseating posturing by the two pathological politcal antipodes (both of which deserve a pox on their houses for letting it rot this far). The entire 'roll out' was predictably poorly concieved, poorly executed, poorly scaled, poorly managed with expected poor results. There are simply no second-acts in America for bad policy.


ObamaCare was passed to provide insurance for the UN-insured, not for all Americans.  Millions of Americans have been cancelled, denied coverage for pre-existing conditions, and that was the purpose of its origin.  By insuring all of these people, theoretically 100% of Americans could have coverage.  Insurers can no longer JUST insure the healthy, thus making billions of dollars in premiums and paying out only scraps here and there in coverage dollars.  At least that is the theory, and it sure makes sense to me.  It shows the true compassion of the Democratic Party, as they were the only ones who voted for it.


@ReesMoerman Your faBvorite (as you spell it), Ringo Starr INfamously said it all.  After all, who the hell is he?  What are his educational credentials, he can only beat a drum and many, many children can do that as well, so he is far from being anyone to quote.  And if young millennials don't want to sign up, then just let them go without insurance.  Let their parents pay for their penalty of being uninsured, as well as any medical care they might need.  I guess you would rather see America go back to having the insurance companies rule....no staying on your parents' policy until age 27, no insurance for anyone with a pre-existing condition, lifetime coverage limits for everyone, different rates for the different sexes, and let the poor and under-priviledged just go without health care.  Is by any chance you dad's name Mitt? 


@michaels39301 @ReesMoerman Complaint, nor accusation conveys success. Your animated response shows it has hit a nerve, which is not suprising. Truth is always uncomfortable. The situation we find ourslelves in is caused by a lot of very bad multi-generational social policy and our greatest poverty is not lack of money... but lack of imagination. (Ringo Starr by the way if you check history was the drummer of the Beatles.) You simply can't make perfume out of rotting fruit no matter your best intentions. If you look at the way the insurance companies game the system today without Obamcare, we don't realy have true health care insurance in the US anyway. Half of the legitimate claims are routinely dendied, depsite Americans having paid up even with gold plated insurance schemes. So, the whole syststem will soon collapse. Medicare as a system is beyond its "best before date" and decaying in front of our eyes. I am neither liberal or rebuplican. Both parties are a tragic, inpet, and a highjacked venue which cannot come up with one good working model. This is not where workable solutions will come from. The cure is in remonitizing health care, obliterting the expensive middlemen,  with a marshal/universal style plan, fostering affordbale innovation, and putting health-care back into community and mostly non-profit hands by proven institutions with high ethics. Getting rid of the peverse incentives embedded in the system will go a long way to starting this needed reform.


@ReesMoerman @michaels39301 Look at your words:  "complaint conveys success", that is ridiculous.  If a baseball player complains that the umpire's call was wrong, does that mean he is automatically successful in his attempt to change the umpire's mind?  Of course NOT.  Obviously logic is not art of your repertoire.

Re-read my last post, I knew Ringo was a drummer, but the certainly is not a PhD.  

And no-one, I repeat no-one, knows better than I, how insurance companies before ObamaCare GAME the system.  That is why I wrote of my experiences with being denied coverage until ObamaCare miraculously allowed me to get covered, just in time for a necessary surgery.  

I also am quite familiar with Medicare, as I now have it and have enjoyed many of its free benefits, including many, many screenings, including prostrate screening, all at ZERO out of pocket expense.  I addition, I get full coverage for my eye wear, less my usual deductible.  So I am extremely happy with Medicare, and especially with my Humana Medicare advantage plan.

Then you say the secret is in "remonitizing" healthcare.  Just what is remonitizing?  There are not enough proven non-profit institutions in the U.S. to handle the volume of medical care needed overall.