It has been over three years since we first learned of the Affordable Care Act (ACA) aka "Obamacare." During that time, much has been written and said about merits and pitfalls of this legislation. No law is perfect and the ACA is certainly no exception, yet no one can deny that many Americans have already been helped and countless others will likely benefit in the future.
Despite continued criticism of certain provisions by some partisans, U.S. House Speaker John Boehner said unequivocally of the ACA a few months ago: "It's the law of the land."
With Gov. Tomblin's bold and much-appreciated announcement that West Virginia will expand Medicaid, attention should now be turned to assuring that all who are eligible will get assistance.
Starting Oct. 1, many middle-income consumers in all states will be able to choose new affordable health insurance options (often assisted with large federal subsidies) through each state's own Health Insurance Marketplace. Also, in West Virginia and the other Medicaid expansion states, other lower-income citizens will be able to enroll in expanded Medicaid.
In maximizing enrollment of those newly eligible, it's important not to overlook the young and healthy. This expansive approach will improve the state budget, hospitals' bottom lines, and businesses' financial outlook by creating a lower-risk health insurance pool. Most importantly though, it will enable more individuals to gain coverage and have better lives.
To do this most effectively, we need a comprehensive plan and, because of the lateness of our Medicaid decision, being ready for enrollment Oct. 1 and implementation Jan. 1 will be an enormous challenge. The New York Times has called this "one of the most complicated and far-reaching social undertakings ever." Many states do indeed have a significant head start on us. The good news, though, is that we may be able to learn from these states, particularly those that have expanded Medicaid, since there will almost certainly be common enrollment for Medicaid and the Marketplace, as some folks have income levels on the borderline.
Surveys show that a high percentage of those who stand to be helped are unaware of their good fortune. To reach out and convince them of the benefits of coverage, we must utilize two different strategies -- face-to-face interaction and the use of mass media. The process of personal consumer assistance will happen in many ways, by many types of individuals, and in many different venues.
Navigators, in-person assisters, certified application counselors, agents, brokers and web-brokers are among those who will play a role in educating consumers about their options, help them receive eligibility determinations, compare plans, and enroll them in either Medicaid or the Marketplace. They will do this in locations such as the DHHR offices, community health clinics, hospitals, public schools, private physician offices, churches and nonprofit organizations.
Mass media will be needed to connect with all the newly eligible, but particularly the "young invincibles." Just recently, the Obama administration contracted with a large public relations firm for nationwide promotion and also announced with great fanfare that the application and enrollment process will be much simplified. To complement this, strategies at the state level should include outreach utilizing newspapers, TV, radio, social media, grocery stores, discount retailers, high school football games, and even the WVU and Marshall broadcast networks.
There are innumerable moving parts -- new rules and regulations come down every day -- and many of the affected parties are understandably nervous about uncertainties ahead, despite much preliminary work by the state Office of the Insurance Commissioner. The stakes, though, are incredibly high for us to get this done right and on time. If it's any consolation, the Commonwealth of Massachusetts faced the same enrollment and implementation challenges six years ago and -- despite similar forecasts of "failure" then as we hear today -- they now have a system that is generally popular, has done much of what it promised, and, as Americans saw only a few weeks ago, performed spectacularly in the face of unspeakable tragedy.
After three years of wandering through the wilderness, we now know where we are going and have a unique opportunity to do something that will help state government, our citizens and our businesses, and make us doubly proud to be West Virginians during our sesquicentennial year. Yet, it will not be easy and we cannot expect someone else to do it. Each and every one of us must contribute and take ownership of our success.
Dr. Foster is a Charleston physician and former state senator who crusades for medical reform.