Big or small?
The latest just-published edition of Health Affairs has a sobering reminder written by Tricia Brooks ("Open Enrollment, Take Two") that the healthcare marketplace wars will recommence on November 15.

That's when open enrollment starts all over again. While the good news is that more than 7 million people got health insurance through the on-line marketplaces, the bad news is that there are now 7 million people who will have to use the process again to get their insurance renewed.

While Dr. Brooks is generally upbeat and hopes our politicians will put their constituents first, the Population Health Blog asks.... what could possibly go wrong?

What the PHB learned.....

Development work isn't finished yet.  The back-room and behind-the-scenes web machinery dealing with application questions, required consumer notifications and eligibility issues are continuing to get tweaked. In addition, the Feds are working to upgrade the electronic and other processes that are necessary to verify identity and immigration status. Plus, it has yet to be fully integrated with the commercial marketplaces, Medicaid and the CHIP agencies.

It is also possible that during the renewal process, persons who underestimated their income in the process of applying for tax credits may be subject to claw back, and the individual mandate's tax penalty will rear its ugly head.  We don't know how consumers will react.

It also remains to be seen how many consumers will understand the financial assistance or miss the deadline. Look to the Administration launch reprise of a marketing campaign that encourages "tell your friends and family" word-of-mouth.

And then there is no guarantee that many states will want to - or be able to - fully cooperate.

What went unmentioned is the "wild card" of the fall political campaign.  All of the members of the House of Representatives, a third of the Senate and many Governors will be spinning Obamacare.  Thanks to the fog of political war played out our TV screens, individuals may be entering the open enrollment period with a whole new set of opinions and apprehensions.

Stay tuned!

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