It's the start of what's expected to be a coordinated effort by the White House, congressional Democrats, and their allies to focus attention on why the Patient Protection and Affordable Care Act was passed. Democrats want to return to their message about the benefits of the law and the importance of Americans signing up for coverage, after spending two months in damage control because of the federal website debacle. But everything depends on the federal website that serves 36 states working effectively, which remains uncertain as the Dec. 23 deadline for buying coverage effective Jan. 1 draws near and hundreds of thousands of people try to sign up. Congressional Democrats facing re-election next year are watching nervously.
“I've said very clearly that our poor execution of the first couple months on the website clouded the fact that there are a whole bunch of people who stand to benefit,” the president said. “Now that the website is working for the vast majority of people, we need to make sure that folks refocus on what's at stake here, which is the capacity for you or your families to be able to have the security of decent health insurance at reasonable cost.”
Enrollment surged in November in a number of states operating their own insurance exchanges, and there have been reports that the federal website is working considerably better for people seeking to sign up for coverage, though there also have been reports of some continuing problems and delays.
Some observers questioned how much impact the president's comments will have, given the four years of rhetoric pro and con surrounding the Patient Protection and Affordable Care Act.
“How many more times does he have to deliver that message, and is that message too late?” said Sarah Bassler Millar, a partner and vice chair of the employee benefits and executive compensation practice group at the firm Drinker Biddle & Reath in Chicago.
Those Americans who will now have coverage for the first time or who have better or cheaper coverage because of the law don't need to be convinced of the law's benefits. “But there are a lot of people who were happy with their coverage—maybe because they didn't have debilitating health issues—and they're seeing changes and questioning why those changes have to be made,” Bassler Millar said.
Obama also said that the insurance exchanges are just getting started, and that the law won't be repealed as long as he's president. That drew cheers and applause. “If I've got to fight another three years to make sure this law works, that's what I'll do,” he said. “That's what we'll do. But what's important for everybody to remember is not only that the law has helped millions of people, but that there are millions more who stand to be helped and we've got make sure they know that.”
He then said consumers should not be discouraged by HealthCare.gov's initial problems, and asked for his listeners' help in educating the public about their experiences with the law.
“We've learned not to make wild promises about how perfectly smooth it's going to be at all times,” Obama said. “But if you really want health insurance through the marketplaces, you're going to be able to get on and find the information you need for your families at HealthCare.gov,” he added. “So if you've already got health insurance or you've already taken advantage of the Affordable Care Act, you've got to tell your friends, tell your family, tell your co-workers, tell your neighbors.”
Obama mentioned a letter he received in October from Dr. Sam Weir, associate professor of family medicine at the University of North Carolina Health Care System.
In an interview with Modern Healthcare, Weir said he sent the letter to tell the president that he's grateful his patients can now get the coverage they need, and that the law is about more than a website. His concern now, he said, is whether there will be an adequate supply of doctors and other providers to handle the increased demand for care from millions of patients who now will have either private insurance or Medicaid coverage.
Weir said that for primary care in general—and for family medicine in particular—providers need to become better at managing “larger panels of patients,” and he thinks the answer to that lies in careful implementation of the patient-centered medical home.
“But it's going to be a challenge,” he said. “Will we be able to manage the patients coming in, or existing patients coming in now with better coverage?”
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