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By now, anyone who’s been paying attention — and probably even many who aren’t — knows about the disastrous start of the Affordable Care Act’s (ACA) federal Health Insurance Marketplace. It was described, at best, as “glitchy” and, at worst, as evidence of “stunning ineptitude.” And this was from ACA supporters. Even President Obama said his administration “fumbled” the rollout.
So, yes, it’s been messy. And maddening. Even mystifying. And, yet, at the same time, magnificent.
Because, despite all the problems — some of which have been fixed, others which remain — the Marketplace represents a profound turning point for the American health system, for social justice, and for human rights.
Never again will we segregate patients based on health and cruelly deny insurance coverage to those who are sick and need it most.
Never again will cancer patients, or diabetics, or kids with asthma, or anyone with a pre-existing condition, be denied or charged more for coverage that could improve, or even save, their lives.
Never again will women pay more for health insurance because of their gender.
Never again will insurers cancel policies just when patients start making high-cost claims.
Never again will the sickest patients face annual or lifetime limits on their coverage.
Never again will insurance companies spend excessive amounts on advertising and executive salaries while skimping on health care spending for their customers.
Never again will patients pay out of pocket for preventive services like flu shots and mammograms.
Never again will insurance companies exorbitantly raise rates without public notice.
Never again will insurance policies neglect coverage for essential services like doctors, hospitals and prescription drugs.
Never again will African Americans, Hispanics, and other communities of color and minority groups face massive rates of uninsurance within their populations.
The ACA is not perfect. There are still cracks in the system, most notably for those who live in states like Kansas and Missouri that refuse federal funding to expand their Medicaid programs.
We need to design better ways to reward providers for delivering the right care, at the right time, in the right place. We need to educate patients to be better health care consumers. Perhaps most importantly, we must continue the progress of the last few years in holding down the growth in health care costs.
So, we still have a long way to go. This is the beginning, not the end, of health reform. But we’ve turned the corner.
The Marketplace website will probably continue to frustrate us as we approach the March 31st enrollment deadline. But next year it will be better and within a few years the messy start will largely be forgotten.
And, most importantly, millions more Americans will have the security of health insurance coverage.