Late yesterday I attended a Netroots Nation panel on Obamacare implementation featuring Alice Chen and Carolyn Senger of Doctors for America, Anthony Wright of Health Access America, Adam Stalker of Enroll America, and California health care activist Kenya Wheeler. It was in part a fast information download on the status of and issues facing the implementation process in the states, and in part a pep rally to re-engage progressives who fought for ACA to stay focused on the critical tasks just ahead.
The big glaring number hanging above the session was the poll finding that 72% of the uninsured know little or nothing about ACA eligibility, and even more crucially, about the relatively short window during which enrollment in health care exchanges will occur. Beyond the process of education and enrollment, the panel talked a lot (with California, unsurprisingly, serving as the poster child) about what states could do, or be harrassed into doing, not only to implement Obamacare fully, but to deal with the “glitches” in the law that Congress won’t fix so long as Republicans continue their “repeal it, don’t fix it!” posture.
By necessity, of course, the focus was on states where implementing and even improving the ACA is politically feasible. In the spirit of this “accentuate the positive” theme, there was no mention at all of the fate of those people who are about to fall into what I’ve labeled the “wingnut hole”–the coverage gap which will deny Medicaid eligibility to those with incomes below the federal poverty level, who also don’t qualify for ACA’s federal subsidies for purchasing insurance on the new health exchanges. After the session I asked Dr. Chen about this issue, and about all she could do was to sadly shrug and express the hope that this manifest injustice would get some serious attention in the “rejectionist” states.
Washingtonians are used to viewing Obamacare implementation as sort of a race between public understanding of the huge tangible benefits of the law and the political pressure in Congress and in the states to screw it all up. That’s still true, but at a much more basic level it’s a race against the clock for hundreds of thousands of public officials, health agency personnel, advocacy groups and their activists, and health care providers, whose relative success in realizing the vision of universal health access will affect millions of Americans for years to come.