The central feature of Obamacare – getting the uninsured to sign up for health insurance – is due to start on Oct. 1, less than four months away. But both the federal and state governments are behind in their preparations.
That’s the conclusion of two reports issued Wednesday by the congressional Government Accountability Office (GAO) looking at the status of government efforts to set up online “exchanges,” or marketplaces, for both individuals and small businesses.
“Much progress has been made, but much remains to be accomplished within a relatively short amount of time,” said the GAO report on the establishment of “federally facilitated” health-insurance exchanges for individuals. Those are the exchanges being set up for the 34 states that opted not to set them up themselves.
For example, the report cites a two-month delay in funding awards for “a key consumer assistance program” known as Navigators, causing delays in training. The report also says that the federally created exchanges rely on the states to implement certain functions, and some are behind schedule.
Passing the Patient Protection and Affordable Care Act (ACA), or Obamacare, remains the signature accomplishment of the Obama presidency, and the law’s success is crucial to President Obama’s legacy. One year ago, most of the law survived the scrutiny of the US Supreme Court, but fierce resistance from Republican governors and members of Congress has put a drag on implementation.
The Department of Health and Human Services (HHS), which is overseeing implementation, says the new marketplaces will open on time. People who sign up will be covered as of Jan. 1, 2014.
Polls show that a high percentage of Americans – upwards of 50 percent – are not aware that the ACA is the law of the land, that it contains a mandate to buy insurance, and that subsidies will be available.
Last month, HHS Secretary Kathleen Sebelius encountered controversy when it was revealed that she had solicited private money for groups that are working to spread public awareness about Obamacare, including information about the new exchanges that will offer federal subsidies to those who qualify.
At a congressional hearing earlier this month, Secretary Sebelius defended her fundraising calls on behalf of an outside group that is promoting Obamacare. She said she asked the Robert Wood Johnson Foundation and the tax preparation company H&R Block to donate to the group Enroll America, and contacted three other entities just to describe the group. All of her actions, she said, were legal, noting that previous HHS secretaries took similar action to help with implementation of new programs providing health insurance to children and prescription drugs for seniors.
On Tuesday, Enroll America launched a grass-roots campaign to spread the word about Obamacare, and get people to sign up. The group is closely aligned with the Obama administration and run by Anne Filipic, former deputy director of the White House Office of Public Engagement.
Under Obamacare, insurance companies can no longer turn away people with preexisting conditions. And so a crucial aspect of implementation is getting enough young, healthy people to enroll to offset the cost of insuring older, less-healthy enrollees. The Congressional Budget Office expects some 7 million people to sign up when the exchanges open on Oct. 1, eventually reaching 22 million.
But Republicans are jumping on the GAO warnings as evidence that Obamacare isn’t ready for prime time.
“GAO report confirms our suspicions about implementation of health care law #TrainWreck,” Rep. Sam Graves (R) of Missouri, chairman of the House Committee on Small Business, tweeted on Wednesday.
A new poll out Wednesday on health-care reform by the Kaiser Family Foundation demonstrates the Obama administration’s continuing challenges. Negative views of the law still outweigh the positive, 43 to 35 percent. Though Kaiser points out that the negative views are a mix of people who think the law goes too far in changing the health-care system (33 percent) and those who think it doesn’t go far enough (8 percent).