9. I'm retired. What do I need to do?
Anyone on Medicare can ignore the fuss. Nothing changes about how you pick a plan or buy a supplemental policy.
Yet keep your guard up, or tell your parents to. In July, the Federal Trade Commission warned that identity thieves are already calling seniors and claiming, under the guise of Obamacare, that they must confirm personal information such as Social Security numbers or bank accounts.
"With a new program this big, you can expect scam artists," says Nicole Duritz, who runs AARP's education and outreach on health care.
Early retirees, on the other hand, may eventually have to act. In the coming years, companies that provide health benefits to retirees who are not yet eligible for Medicare may instead give them funds to buy their own policy on an exchange, says Ron Fontanetta, who heads the health care practice for consultant Towers Watson.
10. This all sounds pretty complicated. Do we have a logistical disaster in the making?
Given the scope of what the government is aiming to pull off, a little skepticism is understandable. The Federal Data Services Hub will link 51 exchanges, insurers, the IRS, the Treasury Department, Homeland Security, the Social Security Administration, and state health care agencies.
"This is one of the biggest IT projects ever initiated by the federal government," says Dan Schuyler, director of exchange technology at consultant Leavitt Partners, which helps states create exchanges.
In June the Government Accountability Office released a report questioning whether the federally run exchanges would be ready. In August the Office of the Inspector General raised alarms over whether the system will be adequately secure. Health and Human Services officials reiterated that the Oct. 1 schedule stands.
The likeliest scenario, say many, is that the exchanges open on time, but applying goes slowly, especially if you're seeking a subsidy. "The doomsday scenario is, the system crashes, but what's more likely is that people just experience delays and frustration," says Kevin Walsh, managing director of government health care solutions for Xerox.
Getting answers to questions may prove hard as well. Every state will have help lines and in-person assistance, but as of mid-August some states had not yet finished hiring or training staff. If you can't find help, keep in mind that many traditional insurance brokers will be certified to sell plans on the exchange. Find one at nahu.org or iiaba.net.
11. Could the government still pull the plug?
Sure. This year the Obama administration has already delayed several provisions of the law until 2015, including the rule that large employers must offer insurance. But so far the government is standing firm on the individual mandate, and new research sheds light on why that may be.
Because most large companies already offer health coverage, eliminating the employer mandate will have little effect on the number of uninsured. The Urban Institute estimates it will be the difference between a 10.1% and 10.2% uninsurance rate.
Putting off the individual mandate, on the other hand, will dramatically cut the projected number of insured Americans next year, trimming today's uninsurance rate from 16% to just 15.1%. "It's important right from the get-go to get young, healthy people into the market," says Timothy Jost, a law school professor at Washington and Lee University. "I don't think the government will delay."
12. What happens if too many opt out?
The success of Obamacare hinges on a delicate balance: Insurers have to cover everyone, regardless of how ill they are, and everyone has to have coverage, even those who never need to see a doctor (a group that's called the "young invincibles"). Anyone with health problems will almost certainly sign on. And the hope is that subsidies will bring the healthy onboard too.
If too many invincibles decide to pay the modest penalty instead, people who don't qualify for a subsidy will face higher premiums in 2015. In that case, subsidies should be enough to prevent a complete downward spiral of the healthy dropping out, says Rand mathematician Carter Price.
Still, persuading the young to get onboard is a priority for the federal government and supporters of reform. The comedy website Funny or Die is creating videos, Walgreens will be handing out pamphlets to customers, and ad campaigns are targeting moms. What happens if the efforts fall flat? As of now, no Plan B.
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