Tarnished by shutdown battle, health law moves ahead

Crucial provision on marketplaces debuts today

AP file photo

WASHINGTON — Americans lacking health insurance will be able to sign up for coverage beginning Tuesday, federal officials say, despite Tea Party Republicans’ efforts to torpedo President Obama’s health care law or cripple its implementation.

But the debut of the health insurance marketplaces — a critical component of the law that mandates most Americans obtain insurance by January — has been tarnished, politically and practically, by the threat of a government shutdown.

Consumer advocates and health policy experts say recent talk of a shutdown has stirred up even more consumer confusion over an already controversial law. They fear that the added uncertainty will deter people from signing up for health insurance.


“This is a distraction to people, and threatens the ability to reach out to those who can really benefit from enrollment,” said Dr. Jay Himmelstein, chief health policy strategist for UMass Medical School’s Center for Health Policy and Research. “A lot of people think the bill has either been repealed or will be repealed imminently, so why should they take the time to invest in learning about something that is going away?”

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The Obama administration, including the president himself, is trying to reassure the public that benefits under the 2010 law remain secure. Obama’s key domestic achievement has survived a Supreme Court challenge, a presidential election, and more than 40 attempts by House Republicans to repeal it.

“Let me be clear about this: An important part of the Affordable Care Act takes effect tomorrow no matter what Congress decides to do today,” Obama said Monday evening, referring to the tens of millions of Americans who will be able to shop for insurance on healthcare.gov. “The Affordable Care Act is moving forward and funding is already in place. You can’t shut it down.”

In its contingency plans in the event of a shutdown, the Department of Health and Human Services was prepared to furlough 40,512 employees, or more than half of its staff. However, many of the employees from call center operators to computer technicians and administrators, all responsible for overseeing the rollout of the Affordable Care Act, would be retained, said an HHS spokeswoman.

Even in Massachusetts, whose groundbreaking universal health care law served as the model for the federal overhaul, public confusion abounds.


At a fund-raising walk for a senior center in Dorchester on Saturday, many participants expressed worries about the “ills of Obamacare because all the fear mongering coming out of Washington,” said Amy Whitcomb Slemmer, executive director of Health Care For All, a Boston-based advocacy group.

“When I said that we have Obamacare here already, they were surprised,” Whitcomb Slemmer said. “At first they disagreed with me, but after a 10-minute conversation they seemed convinced that all would be well and that next Saturday would be exactly like last Saturday, or even better.”

Beginning at 8 a.m. Tuesday, Bay State residents will be able to apply for insurance online instead of filling out a paper application that now takes 30 to 45 minutes to complete, said Jason Lefferts, spokesman for the Commonwealth Health Connector, as the insurance marketplace is called in Massachusetts.

The new online application will eventually be connected to a federal data hub that will be able to determine immediately whether individuals qualify for federal subsidies. That feature will not be ready until November, so applicants seeking subsidies must wait 30 to 45 days to find out how much their subsidies will be.

About 150,000 low-income Massachusetts residents who currently qualify for state health insurance subsidies must choose a new plan and apply for federal subsidies, Lefferts said.


White House officials, mindful that any snags will become instant fodder for Republicans opposed to the health law, have warned that technical glitches will be likely during the initial weeks as the marketplaces come online.

‘The Affordable Care Act is moving forward, and funding is already in place. You can’t shut it down.’

“News flash: there will be glitches. And when there are glitches, we will fix them,” said David Simas, a White House adviser overseeing the government’s national marketing of the health law, during a briefing with reporters last week.

The federal government helps oversee insurance marketplaces in 36 states, including in Maine and New Hampshire; the rest of the states are running their own marketplaces. Consumers are supposed to be able to shop for health insurance online as easily as they would compare prices of plane tickets.

Those who qualify for federal insurance subsidies will still be able to receive them in the event of a shutdown, according to HHS, because the pool of money that funds the subsidies comes from mandatory spending and not the annual appropriations that are the subject of political wrangling.

In addition, a federal call center open 24 hours, seven days a week to help consumers apply for insurance will continue to be staffed. And federally-paid staff, known as navigators, are still fanning out among the states to educate residents about the law and help them sign up.

Republicans on Monday continued to fight the health care law and blamed Democrats for the looming shutdown because Obama wants “to get Americans addicted to the crack cocaine of dependency on more government health care,” Representative Michele Bachmann of Minnesota said.

While polls show the health law remains deeply unpopular in many parts of the country, a CNBC poll last week found that 59 percent of Americans were opposed to defunding the health law if it meant shutting down the government or a government default; only 19 percent favored such a move.

“Opponents of the law continue to not want to accept reality,” said Mitchell Stein, policy director of Consumers for Affordable Health Care in Maine, whose Republican governor has refused to accept federal money to expand Medicaid coverage to more low-income residents.

Americans will be able to enroll in the new marketplaces from October through March, with coverage benefits beginning Jan. 1 for those who sign up by Dec. 15.

Still, nearly three-quarters of the uninsured do not know that people will be able to begin shopping for health insurance starting October, according to Kaiser’s latest monthly poll released on Saturday.

“People will naturally be wondering if the exchanges will really open tomorrow if so many things are shutting down,” said Jon Kingsdale, former head of the Commonwealth Health Insurance Connector Authority and now a health care consultant helping other states develop insurance marketplaces. “A government shutdown will add to people’s mystification about what all this is actually about.”

Matt Viser of the Globe staff contributed to this report. Tracy Jan can be reached at tracy.jan@globe.com.