WASHINGTON (AP) — Three months before uninsured people can start shopping for coverage, some big unknowns loom over the Patient Protection and Affordable Care Act (PPACA).
The surprise announcement this past week that the White House is delaying a requirement that many employers offer coverage raised questions about other major parts of the biggest expansion of society's safety net since Medicare nearly 50 years ago.
One delay may not matter much in the end. People will judge the law — President Obama's law — on three main points: premiums, choice and the overall consumer experience.
Only partial answers can be gleaned now, and they don't necessarily fall along predictable lines.
Basic economics suggests premiums will be higher than what many people who buy their own coverage pay now, especially the young and healthy. The new policies provide better benefits, and starting next year, insurers won't be able to turn away the sick. But the pocketbook impact will be eased by new tax credits and other features that people soon will discover.
As for choice, PPACA isn't likely to deliver the dozens of options available to seniors through Medicare. But limited choices may not be seen as a step backward because in most states the individual health insurance market is now dominated by a single insurer.
The consumer experience shopping online for insurance remains the biggest unknown — and a risk.
Squads of technology experts — federal, state, insurer and contractor employees — are trying mesh government and private computer systems together in ways that haven't been tried before. It may not feel like Amazon.com. Many people could default to enrolling the low-tech way, through call centers or even through the mail.
Health care politics divided the nation even before the passage of PPACA in 2010, and the law's full implementation four years later is shaping up as a tale of two Americas.
The rollout might go well in mostly Democratic states that prepared, while it clatters and clunks in mainly Republican ones that resisted Obama's law. Millions of poor people will be denied coverage next year because they live in states that are refusing the law's Medicaid expansion. But most workers now covered on the job should not see major changes.
With political strategists already honing health care attack lines for next year's congressional elections, a former U.S. health secretary has an admonition for both parties. Mike Leavitt put in place the Medicare prescription drug plan for President George W. Bush in 2006 and now heads a consulting firm that advises states on PPACA.
"It's important for all of us to remember that it's not political parties who are affected in the long run, it's people," Leavitt said recently. "It will be millions of people … many of whom are the less fortunate, and those who have dramatic health problems."
A closer look at the three big questions:
Premiums
The Obama administration sees encouraging signs in states that have released premiums for next year, as well as from rates filed directly with the federal government but not yet publicly revealed.
"We are seeing increased choice and affordable premiums," said Mike Hash, head of the U.S. Department of Health and Human Services' health reform office.
But what will consumers see?
The data-crunching company Avalere Health found that in nine states that have released premiums, the rates appear to be lower than the Congressional Budget Office estimated when the law was being drafted in 2009.
But Avalere vice president Caroline Pearson acknowledges that doesn't represent the cost comparison a consumer might make. Most people who now buy policies individually could see an increase from what they're now paying.
"The benefit design is going to be richer than what is typically purchased and available today … and the rules require insurers to sell a policy to whoever wants it, regardless of health status," she said.
That still doesn't get you to the bottom line because most consumers will be eligible for income-based tax credits to help pay premiums. The plan they pick also could make a big difference.
Jeremy Gilchrist, a self-employed meteorologist from Winooski, Vt., has been uninsured about four years. In his mid-30s, he's in good health, and he says he can't afford premiums on a skimpy budget.
