Complicated Obamacare clears a very low bar

The following column was published on May 29th, 2013 in the New York Times’ Room for Debate blog, which asked the question, “Is Obamacare too complicated to succeed?”

Is the Affordable Care Act complicated? Of course it is. Even one of its architects concedes that it is phenomenally complex. Why? To pass, it had to be contorted to satisfy a number of special interest groups.

As its major reforms are implemented in 2014, even supporters of Obamacare warn of a rough start. Three of the big obstacles:

1. Those without employer-sponsored health insurance will be required to purchase plans through health exchanges. The vast electronic infrastructure needed to power these exchanges has to be built from scratch, and in many states may not be ready in time. The exchanges’ insurance products could also be expensive, if not enough healthy people sign up. And the method for individuals to apply for these benefits is laughably complex, with the draft application form initially spanning 21 pages.

2. More than 30 million newly insured patients will be looking for health providers, only to be faced with long waiting lists. There is a shortage of more than 13,000 physicians, which is expected to grow to 130,000 by 2025, according to the Association of American Medical Colleges. Even by expanding the scope of practice of nonphysician providers, like nurse practitioners, it won’t be enough to meet the primary care demand that Obamacare brings.

3. Some states are still debating whether to expand Medicaid. If they decline, millions of poor Americans would remain without health insurance.

Despite the challenges, there have already been incremental advances with Obamacare. The law has significantly increased the health coverage of young adults. And recent data has shown that health costs have slowed, mostly because of the economic downturn but partly because of provisions in the Affordable Care Act.

And consider two successful health programs that also started poorly. The Children’s Health Insurance Program enrolled only 897,000 kids in the first year of operation, but expanded to four million children within five years. Medicare’s prescription drug benefit (Part D) had significant administrative difficulties when it first began, but once those were corrected, it has since run relatively smoothly.

Besides, compare Obamacare to the alternative, which would be no health reform at all. Almost 50 million Americans would remain without health insurance. And costs would continue to rise from what Americans spend today on health care: 18 cents out of every dollar.

Improving on those numbers is a very low bar to clear. Despite Obamacare’s complexity and the rocky implementation expected, its very existence is a success.

Complicated Obamacare clears a very low barKevin Pho is co-author of Establishing, Managing, and Protecting Your Online Reputation: A Social Media Guide for Physicians and Medical Practices. He is founder and editor,, also on FacebookTwitterGoogle+, and LinkedIn.

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  • doc99

    Kevin, why is it that the only group at the PPACA table which didn’t come away with a “win” is the “House of Medicine?” No SGR fix, No Tort Reform – zip, zero, nada.

    Al Smith said it best – “No matter how you slice it, it still comes out baloney.”

  • Anthony D

    No it simply forces an individual to buy health insurance. That is something that should not be tolerated at all.
    Unions have no power and are forced to give their employees under 30 hours or else be fined by the government. So businesses coup by giving less hours with more work, or just hiring more people. So the economy of the middle class and lower class will always be non-existent.

    His health insurance scheme is no different than the previous ones. All that matters is a persons income, low income means no health insurance, or very bad coverage, middle income means decent health coverage, and those with high incomes….well you can no doubt guess their position is
    just dandy.

    A shame really how the US has become what
    it had once fought against. We claim to stand for liberty and,democracy but all we have done is spread our imperialism to other countries and neglected our own people, and that is the greatest crime of all

  • RIchard Feinman

    My understanding is that Obamacare is a result of trying to accommodate the TP-GOP who were determined to maintain the zero-progress-I’m-alright-Jack health care plans of the eight years of the Bush administration. A more comprehensive, simpler system should have been forced through but — this is not my area of expertise — maybe that was not politically possible. Is the health care system Ok? If not, why didn’t the TP-GOP fix it? Anyway, it’s the law of the land. Get with it. Try to make it work instead of trying to bring America down just so you can defeat Obama.

  • Dorothygreen

    Nice article. The ACA has some aspects of the Swiss health care system. Unfortunately, it doesn’t look like Congress will see this system makes the best sense for the US. Too bad because it should satisfy both sides of the political aisle.

    One just need google Switzerland Health care and come up with many articles that describe it – outlawed for profit insurance for essential services, government negotiates prices with all players and insurance does all administration. There is no such thing as Medicaid or even Medicare (about the only part of the US system the Swiss may want to adopt)

    It’s better for the US than all rest. There is choice and insurance companies can make profit on supplemental.

    We might not need a 21 page application or thousands of navigators if Congress really looked closely at a real model of a health care system for the US,

    One caveat. Switzerland has a 9% obesity rate which is certainly reflective of a mostly healthy diet. This compared to the 34% in the US is what will ultimately prevent the health care cost curve from bending even after dust of implementation of universal health care clears.

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