Obamacare at critical juncture

There are good reasons to applaud the advent of Obamacare — among them, millions more people having access to health insurance and regulations targeting fraud and waste of the public money that underwrites Medicare and Medicaid. But the Patient Protection and Affordable Care Act, passed a full three years ago, remains a mystery to many. That has to change, and the clock is ticking.

President Barack Obama and his administration, having promoted Obamacare as the future of health care in America, bear some responsibility for the less-than-stellar record of educating the public about the programs. That’s especially true given how important bringing the full spectrum of consumers into the health insurance system will be to the success of the effort.

Hawaii has been endowed with a relatively low rate of people lacking health insurance, thanks to its long-established Prepaid Health Care Act, passed in 1974. But even though the islands face a less-daunting enrollment push than other states, there are still an estimated 100,000 people here who lack insurance, and the government needs to get their ear. Especially critical will be healthy young people, who may not buy insurance but are important in balancing out insurance risks.

A lot of the outreach work will be done through the Hawaii Health Connector, the nonprofit that is creating the online marketplace through which most of the uninsured will be able to shop for coverage, starting Oct. 1.

Although there have been assurances that Hawaii will be ready, that date looms, almost menacingly. A lot of outreach will be necessary to educate the uninsured — about 7 to 8 percent of the population — and guide them through the hoops of buying insurance online for the first time ever.

Oct. 1 marks the start of enrollment, three months before the law starts holding people accountable for having health insurance at the top of the new year. For most people who get insurance through their employer, thanks to the state’s own health care mandate on businesses, they don’t have to do anything. It’s the rest of the market that needs to be rounded up.

Already there’s been a considerable investment in getting people into the insurance pool. In Hawaii alone, the federal grants provided to get the Connector up and running have totaled $205 million. The largest share of that, $128 million, came in April, through a multiyear grant from the U.S. Department of Health and Human Services.

The money will pay for a customer service call center, consumer assistance program, general operations and maintenance for the Connector through December 2014. Some of the money is being spent on grants that the Connector will disburse to local organizations to help with the educational program.

Those grants are due for release soon, said spokesman Brian Fitzgerald. We hope that’s very, very soon because there’s no time for further delay in an outreach program.

The bottom line is that in order to keep insurance rates from skyrocketing, the risk has to be spread among young people, who tend to generate less medical costs, as well as older, sicker individuals.

In Hawaii, Fitzgerald said, the uninsured group now includes the so-called "young invincibles" — young adults who decide to take a chance they won’t need medical care rather than pay for insurance. But it also includes a range of other people, such as adults of all ages who have lost employment in the economic malaise and never regained health coverage.

There are sizable subsidies for lower-income and gap-group individuals, as well as tax credits to help small businesses purchase insurance affordably. The Connector Web portal links with federal and state databases and calculates all this to make the choices clear to the consumer.

Considering how many of these databases are outdated or otherwise proprietary to a specific government agency, Fitzgerald said, making all the computers talk to each other is one reason the Connector costs are so high. Let’s hope the real work of getting the public primed for enrollment starts within weeks.

That’s the only way all this investment can pay dividends, in the form of a system of medical care that makes everyone healthier.