As 2013 ends and the Affordable Care Act continues to work out its policy and technology kinks, things are starting to look up for the health care law. An estimated 2 million people have enrolled through the state and federal exchanges, and most of the major rollout flaws are out in the open, or will be after January 1. The benefits are also more apparent. Still, 2014 will give detractors and critics plenty to blame the law for with varying levels of reasonableness. The cancelled plan controversy will turn to employment-based coverage, the health care industry will be afraid to try new things, and states that didn't expand Medicaid will complain about where your federal tax dollars are going.
Cancelled employer-based coverage
The CBO estimates that there will be 6 million fewer people enrolled in employment-based coverage by 2016. Many would argue that Obamacare raises prices for small business, and this year small mom-and-pop shops like this multibillion dollar investment banking company complained about rate increases that haven't happened yet.
Some analysts argue that reduced employer insurance is part of an ongoing business trend towards reduced benefits in the face of rising medical costs that has little to do with the health care law, according to Kaiser Health News. But that point of view acknowledges that the health insurance industry wasn't perfect before Obamacare, and will most likely be ignored, leading to another year of cancelled plan stories.
The health care industry's fear of new technology
On October 1, 2014, the health care industry will go through the debut of a new, highly technological system headed by the Centers of Medicare and Medicaid Services. This time around the change will affect the medical billing system used by insurers and hospitals, and the industry will switch to a set of computerized codes that tell patients and insurers how much they should be paying for treatment. As The New York Times explains, doctors are nervous about the shift, because if they don't bill correctly they won't get paid.
This has nothing to do with the health care law, but the bungled rollout of Healthcare.gov has people worried enough to request a delay (the system was originally set to launch the same day as Obamacare) and/or more testing. The center insists the system will be ready by October 1, but it's a little harder to take their word on it after Obamacare.
Being a tax burden
Several states decided not to expand Medicaid, leaving millions of Americans simultaneously too poor and too well off for insurance. States that declined to expand said they couldn't afford to (even though the government will cover 90 to 100 percent of costs over the next few years). As a new study shows, states that did not expand Medicaid are actually losing money, by paying federal tax dollars towards an expanded program they don't benefit from. For every dollar Mississippi spends on funding the expansion in other states, it would have received $8.03 in return. Meanwhile Vermont's return on investment is unlimited, since it gets back more than it puts in. Fiscal conservatives, of course, will paint this as another example of the federal government's largesse, needlessly throwing away money to insure low-income adults.
Conservatives have already complained that Obamacare uses your tax dollars to fund everything from abortions, paying the Raiders to advertise the law and this "Drop It Like Its Hot" parody Obama video from California Democrats. There are betters ways to spend money than a fake B-Rock Obreezy video (sample lyric: “So don’t stand and diddle, my health care’s the shizzle / It’s chock full of top notch health care provizzles"), but Medicaid expansion is undoubtedly one of them.