(Bloomberg) -- After three months of turmoil surrounding the rollout of Obamacare, the country faces an historic turning point on Jan. 1.
From emergency rooms to pharmacies to company human-resources departments, changes will unfold within the U.S. health-care system as the nation guarantees insurance coverage to all Americans for the first time, a goal that has eluded presidents and lawmakers since the end of World War Two.
Beginning with the New Year, insurance companies can no longer refuse to cover people because of sickness, charge them more than healthy customers or drop them when they fall ill. In return, most Americans are required to have a health plan. Some of the 19 million Americans who buy insurance on their own will find their new plans are more expensive with fewer treatment options than before as insurers seek to contain costs.
Millions of people will now be covered for the first time. Benefits will be expanded,
About 1.1 million people selected health plans in time to have coverage in January using the federal enrollment system, which covers 36 states including Texas, Florida and
Hospitals, doctors
Hospitals and doctors have been preparing for the insurance expansion promised by the Patient Protection and Affordable Care Act since its passage in 2010 by merging into larger institutions and redesigning the way they deliver care to take advantage of incentives in the law. The government has designated about 360 medical systems as
Better coordination for elderly patients, the government hopes, will translate to a more efficient health system for all Americans as insurance coverage expands. That proposition is about to be put to the test.
Beginning Jan. 1, the law bars insurers from rejecting consumers who are sick or charging them more. In fact, companies will no longer ask about prospective customers health beyond the question of whether they smoke. It will be illegal for insurers to impose annual dollar limits on care, and they must cover a standard set of benefits nationwide.
Preventative services
People who are entering the market for the first time also will gain benefits required since 2010, including access to many preventive services without any out-of-pocket expense and full coverage of costly procedures such as colonoscopies and mammograms.
While the number of people initially affected by the expansion will be small, the law promises that Americans no longer need to fear losing health coverage should they leave their jobs.
Having a safety net is a momentous thing; the fact that you can get insurance and youre not left out, Princeton health economist Uwe Reinhardt said in a phone interview. Weve allowed a fair amount of suffering at the fringes of our society and this is designed to mitigate that pain.
In 26 states, Medicaid programs for the poor will be
Peace of mind
Americans across the country will begin new health plans and can have the peace of mind of knowing that if they want to change jobs or start their own business, they will have access to affordable health insurance for their family, Michael Hash, the director of the health reform office at the
By 2016, about 34 million people are expected to
For all its promise, the laws future remains uncertain. It was upheld by the
Falling support
Public support for the law has
A portion of the population that may number in the millions, meanwhile, faces higher prices for health care because insurance companies can no longer provide them a discount on premiums for being young or healthy. People with no health benefits from their employers who earn more than four times the poverty level, about $46,000 for an individual, arent eligible for any government assistance for their insurance premiums.
The governments requirements that insurance plans provide generous benefits and a new tax on plans to help finance the cost of expanding coverage have contributed to premium increases, said Zirkelbach of the insurance lobbying group.
Obamas political opponents predict further snags will emerge as the law takes effect.
Obamacares problems are deeply rooted in its DNA and are far bigger than just a website, Senator
Notably, Hatch said, the law wont tame U.S. health-care spending, which at 17.9 percent of gross domestic product in 2012 --
Additionally, more Americans will lose insurance coverage when their employers drop health benefits in response to the law, Hatch said. Unless many young and healthy Americans sign up for coverage through the new exchanges, insurers are likely to exit the markets or face bankruptcy as the costs of covering the sick soar out of control, he said.
Hatchs party hasnt agreed on an alternative approach to guarantee health insurance for most Americans, and he didnt offer one in his speech. Instead, he said, Obama and congressional Democrats should work with Republicans to replace the Affordable Care Act with something that has a real chance of success.
Theres not much evidence yet that many employers plan to drop health benefits for their workers, Larry Levitt, a senior vice president at the
Were going to keep reforming reform, Levitt said. My guess is this will be close to the top of the policy agenda for quite some time.