The ACP Advocate Blog

by Bob Doherty

Tuesday, October 1, 2013

Openings and Closings

Today is an odd day, even by the strange standards of American politics today.  At exactly the same time much of the federal government was forced to shut down over the Affordable Care Act (ACA)—12 midnight Tuesday morning—that last and most important big piece of the ACA went into effect, the opening of health coverage marketplaces in all 50 states and the District of Columbia. 

The shutdown was the result of House Republicans insisting on defunding or delaying Obamacare, a demand they knew Senate Democrats and President Obama would never accept.  So, when the President and Senate did what everyone knew they would do—rejecting GOP demands that Obamacare be traded away to keep the rest of the government open—there was no time left to reach an agreement that would continue to fund most federal agencies and functions when the end of the fiscal year was reached at midnight.    Immediately thereafter, federal agencies began to methodically close all but their most critical functions.   The CDC immediately terminated support for its annual flu vaccine program and scaled back surveillance of disease outbreaks, the NIH ceased enrolling people in new clinical trials, the FDA ended its routine food safety activities—as the nation’s largest employer, the federal government, furloughed millions of its employees without pay.  But other so-called mandatory programs and payments—including Medicare claims payments and Social Security checks—were unaffected by the partial shutdown, at least for now.

The government shutdown was a sad reflection of the ideologically-driven politics of today, and also a sad day for the country, which will now have to suffer the consequences associated with a suspension of federal programs that almost all of us want, need and depend on to one extent or another.  Our food may be less safe, and we may rue the day when the CDC shutdown left us unprepared for flu and other potentially lethal disease outbreaks.    Many of the poor will go without assistance.  Millions of our neighbors will be temporarily out of work, and because they will have less money to spend, their furloughs will hurt local stores, businesses and services that are still struggling to make it out of the last economic downturn.  The ripple effect, if the shutdown lasts for more than a day or two, could be very destructive to our fragile national economy. 

But for all of the bad news, there was also a reason to celebrate when the clock struck midnight.  Starting at midnight today, the last and most important elements of Obamacare opened for business.  The shutdown managed to shut down much of everything else, but it didn’t shutdown the ACA, which is funded out of “mandatory” dollars that are outside of the usual congressional appropriations process.

Today is a day to celebrate because the ACA, for the first time starting today, will begin to provide guaranteed access to affordable health insurance plans for millions of Americans who can’t get affordable coverage from their employers.  Today is a day to celebrate, because the ACA, for the first time beginning today, will open the doors for persons with pre-existing conditions, like heart disease or asthma, to get affordable insurance coverage. 

Today is a day to celebrate because the ACA, for the first time starting today, begins to put the United States on the path toward near-universal health insurance coverage.  It won’t all happen today or even during the six month open enrollment process that ends in March.  And especially in the first days and weeks, there likely will be marketplace glitches that may slow enrollment. (In fact, initial interest in enrollment today was so high, and so above expectations, that it caused federal and state enrollment websites to crash.)  It won’t all happen this year and next—it is projected that only about 7 million people will sign up for coverage in 2014.  But over the next months and over the next several years, as more Americans become familiar with and enroll in the marketplaces, and as more states accept federal dollars to expand Medicaid, the United States for the first time ever will come close to guaranteeing access to affordable health coverage to nearly all U.S. residents.

So yes, I am celebrating the fact that the Affordable Care Act (Obamacare) is open for business today—having survived the Supreme Court, two national elections, ongoing state obstructionism, and the unrelenting (but ultimately futile) continuing efforts by some in Congress to stop it. 

Today’s questions: What is your reaction to the government (mostly) closing, and Obamacare (mostly) opening today?

1 Comments :

Blogger Harrison Robinson said...

The Affordable Care Act enjoys 10% higher favorable ratings than Obamacare.
I guess I fear that it is the 10% who hate Obamacare but who maybe find the Affordable Care Act as okay that are calling the shots.

The Republican Party blocked a conference committee on the budget for 6 months.
The Senate Budget Committee Chair asked for the appointment of conferees 18 times.
It was blocked by Sen Lee in the Senate and never considered by Speaker Boehner.

The Fiscal Cliff did not include any demands about Obamacare.
The Sequestration went into effect as the House Republicans wanted.

The deficits are falling.
The economy is slowly recovering.

But the name at the head of the federal government is President Obama.
And in the world of the House Republicans, he carries a very very low favorability rating.
He cannot be allowed credit for something positive.

President Obama's favorabiity rating is down by 40% or more in the counties in the South where slaves were held by many. In those parts of the South where that is not true, his popularity is much closer to that 50/50 range found in the North.

I don't know that the House Republicans are driven by racism. I don't know that the 10% who hate Obamacare but find the ACA reasonable are racist.

But I think that we have a continued race problem in the U.S., and I fear that some of the fervor on the extreme right is driving the decisions of the House Republicans, and I fear that that fervor is driven by racism.

Harrison

October 1, 2013 at 9:04 PM  

Post a Comment

Subscribe to Post Comments [Atom]

<< Home

About the Author

Bob Doherty is Senior Vice President, American College of Physicians Government Affairs and Public Policy; Author of the ACP Advocate Blog

Email Bob Doherty: TheACPAdvocateblog@acponline.org.

Share/Subscribe

Bookmark and Share

The ACP Advocate Blog

Recognition

The 2009 Medical Blog Awards
Voted Best Health Policy/Ethics Blog 2009

Healthcare Bloggers
10 Healthcare Bloggers We're Thankful For

Blog log

Health Blog
The Wall Street Journal's blog on health and the business of health.

Health Affairs Magazine Blog
The Policy Journal of the Health Sphere.

The Health Care Blog
Everything you always wanted to know about the Health Care system. But were afraid to ask.

MD Whistleblower
Vignettes and commentaries on the medical profession.

The New Health Dialogue Blog
From the New America Foundation.

Kevin MD
Medical Weblog

DB's Medical Rants
Contemplating medicine and the health care system

EGMN Notes From The Road
Bloggers post from medical meetings, press conferences, and policy gatherings from the U.S. and around the world, providing readers with a tasty analysis of the buzz, the people, and the stories that don't get told.

FutureDocs Blog
A blog dedicated to medical education, news, and policy as well as career advising.

Disease Management Care Blog
An ongoing resource for information, insights, peer-review literature and musings from the world of disease management, the medical home, the chronic care model, the patient centered medical home, informatics, pay for performance, primary care, chronic illness and health insurance.

Medical Professionalism Blog
The Medical Professionalism Blog was created by the ABIM Foundation to stimulate conversation and highlight best practices related to professionalism in medicine.

Powered by Blogger

Comment policy & copyright info