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?
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.Follow @BobDohertyACP
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