Health reform D-Day? Or not for a few more months?

At the AHCJ event we had in Washington, D.C., a few weeks ago, I talked about why there’s nothing magical about Oct. 1 – and why it’s also such a pivotal day.

From a strictly policy viewpoint, today is just the start of a six-month open enrollment period that ends March 31. We won’t really know for some time how many people the exchanges are enrolling or what the emerging risk pool looks like (men versus women, older versus younger, sicker versus healthier). We will probably hear about people having problems getting on the exchange websites or call centers – we won’t necessarily hear as much about people who don’t encounter problems. We’ll find out about glitches – computer problems, call center snags. Some may be serious – but if they are fixed relatively quickly, they aren’t fatal. The Medicare drug benefit had all sorts of snags when it opened, but within a few weeks it was working quite well.

But that’s the staid policy viewpoint and all of us know that – as the government shuts down, as the “Obamacare wars” are well into year 4 – this is not just a policy story. Even the wonkiest, most policy-minded reporters among us know this is a political story, a political dynamic, too. So we aren’t going to be deluged with press releases that say “Health insurance exchanges open – let’s give it six months to make a judgment.” We’re going to be hit with a tidal wave of advocates and enemies trying to seize the message and declare victory or defeat. It will be a battle of the “I told you sos.”

And since the enrollment period – with all its problems and challenges – will go on for three months until the actual health coverage begins on Jan. 1, that’s three more months to focus on problems without being able to point to benefits. That lag will be politically challenging for supporters of the law.

It won’t just be politicians and advocates making snap judgments – some of us may also face pressure from editors to come up with a grand and definitive and immediate answer – it’s working, or it flopped. By, like, noon.

Try hard to keep your eye not just on what happens in the coming hours – but the far more important question of what’s going to happen in the coming weeks, months and years.

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