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Bloomberg News: To tell good Obamacare changes from bad, ask this question

March 10, 2014 - 6:55am

To hear Republicans tell it, the federal government’s constant changes to Obamacare, including Wednesday’s two-year reprieve for insurance plans that don’t meet the law’s tough new standards, rank somewhere between treason and Thanksgiving tofurkey on the scale of outrageousness.

“Blatantly ignoring the law,” said Rep. Joe Pitts of Pennsylvania. “Furiously backtracking,” said Rep. Fred Upton of Michigan. “This will not stand,” said George H.W. Bush. (Come to think of it, that last one was referring to something else. But you get the idea.)

The Republicans have a point. The many updates, exclusions, delays and revisions that have marked the administration’s implementation of the Affordable Care Act in part validate their concerns about how cumbersome the law is. But with an effort as sweeping and necessary as Obamacare, some unwieldiness is inevitable. What’s important is getting the law right, and that calls for judgments separating good changes from bad.

A handy tool for doing this is to divide the administration’s changes into two categories: those likely to advance the primary purpose of the law — increasing the number of Americans covered by high-quality health insurance — and those that are motivated by more mundane concerns, such as politics.

The decision to let people keep their shoddy insurance plans until 2016 — the very plans whose existence this law is meant to extinguish — sits firmly in the latter category, as does delaying the requirement for employers to offer coverage to their workers. You may support or oppose the objective of reducing the drag on Democrats’ midterm campaigns, but let’s not pretend, as the Obama administration does, it has anything to do with improving people’s health care.

Other changes fall into the laudable category. At the same time that it extended subpar plans, the Obama administration announced that states that have so far declined to establish their own health insurance exchanges — 34, by last count — would now have more time to change their minds for next year. State-run exchanges are no guarantee of higher enrollment, but by bringing the decision-making closer to the people it’s meant to serve, they’re likely to help.

Another promising change was last week’s announcement that people who enroll in insurance plans outside of the exchanges will be eligible for the same federal subsidies available to those inside the exchanges. That fix — the one that sparked Pitts’ outrage — is important, especially in states whose exchange websites still aren’t working properly.

Judging Obamacare’s course corrections on this basis is a useful practice to keep in mind as the clock runs down on the open enrollment period for 2014. The scheduled deadline is March 31, but states have the authority to establish “special enrollment” periods beyond that date, and may use that authority to help people who have been unable to sign up because of technical problems.

Any state using that power will draw the ire of the law’s opponents. It shouldn’t care. At the same time, a quest for partisan advantage shouldn’t guide the federal or state governments as they consider future changes to the law. For all sides, the aim should be to increase the number of people covered by high-quality, affordable health-care plans. Everything else is politics.

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