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Assessing the Affordable Care Act: Don't Forget the Context!

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Among the most dysfunctional characteristics of the current political era is the hyperbole that attaches to even minor issues and the inability to acknowledge the importance of context in assessing the importance of events.

Case in point: The overwrought comments about the difficulties with the launch of the website for the federal health insurance exchange.

To be sure, the problems are real and are hindering the ability of many Americans to search the site for information about the insurance options open to them and the subsidies they might qualify for. Moreover, precisely because it is not unusual to miss deadlines in implementing complex programs like this, problems could have been anticipated, and more decisive steps should have been taken to minimize them. It also appears the process could have been managed better.

But let's keep events in perspective. First of all, the problems with the website are technical. They have fixes. Unless it is not operating smoothly by the end of November when the push to meet the first enrollment deadline of December 15 is expected to begin, no great harm will have been done. Understanding the stakes, the administration has already taken steps to improve the management of the website effort and is assuring us that the system will indeed be operating smoothly by then.

So, the website experience does not justify the hysteria. It does not demonstrate that Obamacare is a "disaster." For one thing, in the first few days after the October 1 launch of the health insurance exchanges (about one-third of which are operated by states) millions of Americans logged on in an effort to sign up for health insurance? That is hard evidence that, in fact, people who have not been able to afford insurance in the past value it and want it.

Moreover, instead of being extremely expensive, as the law's opponents have screamed, most comments from people who have actually examined available insurance policies say that they are less expensive than expected -- and, especially when the subsidies are factored in, are affordable by the vast majority of those who have attempted to sign up. And while some complain they cannot keep their employer-sponsored coverage, that is because those policies did not meet the new law's minimum criteria. So, the new coverage is better and for many, it will be less expensive.

It also must be pointed out that many of those in Congress who are complaining the loudest about the difficulties with the website -- are they really concerned about their constituents? -- are the same people who have been railing against the law in the first place.

And it is not just members of Congress: Republican governors and legislatures have refused to take on the opportunity to build their own health insurance exchanges even though they would be able to claim credit for providing insurance to their constituents. Instead, they complain the federal website is not running smoothly.

It is worth noting that some of those who initially refused to expand their Medicaid programs so their low-income residents could get their insurance that way are now coming around. Some of them now understand that it is not only Medicaid that grows, but the state's economy, too -- initially with the feds picking up the entire cost (after a few years, the federal share will decline gradually to 90 percent). Undoubtedly, they have been persuaded by leaders of their health care sectors for whom those funds are revenue. Then, the money their employees spend in the state will be the demand for things sold by businesses operating in the state.

Besides expanding access to health insurance, the Affordable Care Act has other benefits. Insurers must now provide coverage for all who seek it, even those with prior medical conditions, and they cannot cancel insurance for those who use services. Further, they may not charge individuals more because of personal characteristics (except for age) -- even those that increase the risk of needing care. Thousands of young adults up to the age of 26 are still covered on their parents' policies while they continue as students or look for a job with insurance. Private insurers offering coverage to large groups must spend at least 85 percent of their revenues on health services or efforts to improve the quality of care (80 percent for those in the individual and small-group markets). If they spend more than 15 percent (or 20 percent) on overhead, executive compensation, and profit, they must rebate the additional amounts to policy holders. In 2012, almost 13 million people received rebates totaling more than $1 billion. Finally, many provisions encourage reforms that will increase quality and save money.

The ACA may not be the ideal health care reform law, but it is the one that could pass Congress; and it accomplishes much that is good for the society. So, we should remember that as we hear more stories of fixable "glitches" in the roll out of its website.