Pennsylvania vs. Obamacare

Residents of resistant states like Pennsylvania will come to see the health law's many benefits

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In just over three months, starting on Oct. 1, millions of families across the nation will have an opportunity to enroll in health care coverage through the Affordable Care Act, a.k.a. Obamacare.

The full benefits of the law will be most apparent to residents of the two dozen states that plan to fully implement the law and adopt its provisions for Medicaid expansion. Sadly, Pennsylvania is one of the states where residents will not see all of the vast potential benefits of the ACA.

Here are some things to watch for as we approach Oct. 1 -- and the key word in Pennsylvania is "watch," because the law won't be fully implemented here.

First, the focus on the ACA will become increasingly personal and decreasingly political. The closer we get to Oct. 1, the more families will pay attention to the nuts and bolts of the law and how it will affect their lives.

Consumers seeking increased value for their health care dollars will learn how new insurance marketplaces will give them meaningful choices that put them in the driver's seat, enabling them to select health plans best suited for their needs and with access to the physicians they trust.

For the first time, consumers will be able to get financial help to reduce out-of-pocket premium costs. Families that can't pay for health coverage today will soon be looking for details about the new premium subsidies that will make health insurance much more affordable.

People with diabetes, asthma, cancer or other chronic conditions will find that insurance companies can no longer deny coverage or charge discriminatory premiums due to their pre-existing conditions.

While some Republican leaders vow that the ACA will be a top issue in the 2014 elections, political rhetoric will become a sideshow as we move closer to Oct. 1. What really will matter to most Americans will be how the ACA will affect their lives.

Second, there will be significant and perceptible differences from one state to another in terms of health coverage, costs and quality of care. Those states, unlike Pennsylvania, that actively participate in all provisions of the law will fare much better.

The differences between states will show up in a number of ways. For example, states that accept generous federal funding to expand Medicaid coverage for low-income families will show remarkable improvements in reducing the number of residents who are uninsured. Pennsylvania, which has turned a cold shoulder to people who need help the most, won't see these reductions.

States with large numbers of on-the-ground helpers, sometimes called "navigators" or "assisters," will help their citizens much more effectively secure premium subsidies and obtain coverage that is most responsive to their families' needs.

States that implement active oversight of their insurance marketplaces will do appreciably better in decelerating decades of premium increases. Pennsylvania has let this opportunity go, too, opting to have the federal government set up the "exchanges" that will offer policy options to consumers rather than having the state government do so.

But all is not lost for families in Pennsylvania. The third thing to watch for after Oct. 1 is how advances in cooperative states like neighboring New York slowly but surely lead to a reconsideration of Pennsylvania's decision to implement only portions of the federal law.

Eight conservative governors who actively fought the ACA -- including Jan Brewer of Arizona, Chris Christie of New Jersey and John Kasich of Ohio -- have declared their support for the Medicaid expansion, understanding that it would be an act of fiscal malpractice for their states to turn down this federal funding.

These chief executives want to reduce state expenditures for uncompensated care in public hospitals, create new jobs and increase state revenues through increased economic activity -- without raising tax rates. When all the benefits of ACA implementation in cooperating states become clearer, additional conservative governors will want to follow their lead -- perhaps even Pennsylvania's Tom Corbett.

Effective implementation of the new health reform law eventually will spread throughout the country, and this will enable our nation to move closer to providing affordable, high-quality health care to all Americans.

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Ron Pollack is founding executive director of Families USA, a national organization for health care consumers, and founding chair of Enroll America, an organization seeking to enroll all uninsured Americans in health coverage.


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