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Obamacare Lumbers Toward Starting Gate

401(K) 2013 via Flickr

The most sweeping health care reform program since the 1960s is now within six months of its official launch. For better or worse, Maryland is among a handful of states leading the way.

The undertaking known informally as Obamacare is huge and complicated. More than half the 50 states are letting the feds do all the work. And what’s really challenging is that polls suggest many of the folks this health care upheaval is designed to serve don’t know that help is on the way.

Peter Beilenson, former health officer for Baltimore and Howard County who has been working for 25 years to achieve universal health insurance coverage, says the 2010 Affordable Care Act is flawed but a major step forward. “It is nowhere near perfect,” he said. “It is a mish-mash of Rube Goldberg-esque machinations.  But there will be many more covered under this bill and getting appropriate care than there would be without it.”

Thanks to enthusiastic support from its Democratic political leaders, Maryland is among the lead states in preparing to implement President Obama’s health insurance reforms. And thanks in part to $157 million in federal funding, officials say Maryland will be ready on October 1st to start sign-ups for subsidized health insurance for low income folks and those who pose a high risk because of previous health problems.
 Coverage will begin in January.

An ambitious advertising and community outreach campaign is being launched this summer with the hope of ultimately reaching at least half of the 750,000 Marylanders who have no health insurance.  They will be coached on how to apply for coverage offered by competing insurance companies through a state-run exchange.  Individuals and small businesses will also be able to apply for a policy offered by a non-profit co-op run by Beilenson.

Claire Andrews of Families USA, a national advocacy group backing such reforms, stressed the good news.  “Anyone who’s struggling for the many reasons that they may not have coverage now, they can go the individual exchange starting Oct. 1 and they may be eligible for subsidies to make their coverage more affordable,” she said. 

But skeptics of Obamacare, which potentially affects one-sixth of the economy, argue that being among the first off the cliff is no cause for celebration. State Senator Joe Getty, a Carroll County Republican, said his fear is that the Obama administration has vastly underestimated the cost of providing new insurance benefits. “And the fear for Maryland is that we jumped too quickly and too aggressively into it and if it does implode, Marylanders, taxpayers, insurance carriers, doctors are going to be left holding the bag,” he said. 

Much harsher words are coming almost daily out of Washington, where Republicans who gained control of the House too late to stop the enactment of the Affordable Care Act have repeatedly voted to repeal it. The administration’s recent decision to delay until 2015 a requirement that businesses with 50 or more employees must provide them with health insurance gave critics more ammunition to claim Obamacare is unworkable.

Meanwhile, Republican governors from around the nation are refusing to join in the expansion of Medicaid that would finance much of the new health coverage for the poor. They see it as a drain on an already out-of-balance budget.

Carolyn  Quattrocki, executive director of Governor Martin O’Malley’s office of health care reform, said that response seems self-defeating. “It’s perplexing why states are doing it,” she said. “Not only is it an opportunity to cover so many more of the people in their states, but it’s a great deal for states because it’s 100 percent  federally-funded for the first three years.” She noted that the key calculation of Obamacare is that by forcing everyone to buy insurance, premiums paid by and for the young and healthy will help finance care for the old and sick.

“We are all paying a hidden tax to subsidize care for those who don’t have insurance. Hospital emergency rooms don’t turn people away.  So it inures to the benefit of all of us to get more people into coverage.  And I think over time even the states that are lagging behind will realize that.” 

But that may take a very long time.