Opinion: The Next Challenge for Obamacare -- Finding and Enrolling the Uninsured

By Joel C. Cantor

[Joel C. Cantor is the director of the Center for State Health Policy and professor of public policy at Rutgers University. He has authored numerous studies of health insurance regulatory policy, healthcare delivery system performance, and access to care for low-income and minority populations. He serves frequently as an advisor on health policy matters to New Jersey state government. The views expressed in this essay are solely those of the author and are not endorsed by funders of the Center for State Health Policy.]

The road to national health reform has been rough, to say the least. The Patient Protection and Affordable Care Act (ACA) passed Congress three years ago in a cliffhanger vote following the death of Sen. Edward Kennedy and subsequent loss of the Democrats’ filibuster-proof majority. Then the law survived its historic Supreme Court challenge mostly unscathed.

Today, the national health overhaul appears to be withstanding ongoing partisan bickering, with the important exception of a few states in which the Medicaid expansion will apparently not be implemented. The main provisions of the law will go into effect in a few short months. Closer to home, recent decisions from the Christie Administration make the reform path clear in New Jersey -- the federal government will run our health insurance exchange and Medicaid eligibility will be expanded to thousands of uninsured low-income individuals and families.

In spite of surviving the gauntlet thus far, the successful implementation of the health law is far from assured. Potential pitfalls are numerous. One of the most challenging is the construction of the exchange marketplace, which will consist of a federally run website (to be found, ultimately, at healthcare.gov) and call center. Other important steps include the certification of plans to be offered in the subsidized exchange, procurement of “navigators” to find and help enroll eligible uninsured persons, and education of the public about the requirement to purchase coverage and options for doing so. Recent national polls show broad confusion about the reforms (and even that the ACA is the law of the land).

All of the foregoing steps need to be taken well before the annual open enrollment period for subsidized coverage on Oct. 1 this year.

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