The Obama administration accelerated its push to persuade individual Americans to sign up for the most extensive overhaul of the U.S. healthcare system in 50 years, even as the program's foes in Congress fought to delay its launch with the threat of a federal government shutdown.
The new online health insurance marketplaces at the heart of President Barack Obama's Patient Protection and Affordable Care Act, better known as Obamacare, are set to open on Tuesday. The marketplaces, or exchanges, will offer subsidized health insurance to low-to-moderate income families in all 50 states and the District of Columbia.
On the eve of the launch, Vice President Joe Biden and Health and Human Services Secretary Kathleen Sebelius urged millions of uninsured Americans to ignore the battle in Congress and instead focus on the access their families need to medical services.
"Come Tuesday, Americans will be able to see for themselves that the Affordable Care Act isn't actually about Washington politics," Biden wrote in an opinion piece printed in local newspapers including the Des Moines Register in Iowa and the Birmingham News in Alabama. "It's about regular people shopping for insurance they can finally afford, and purchasing security and peace of mind along with it."
State officials and community groups on Monday said they were putting the final touches on their exchange openings. The Department of Health and Human Services said that 900 businesses and organizations had volunteered to explain the new law to Americans nationwide.
The roll-out would proceed even as Republican lawmakers fought to delay Obamacare by attaching amendments to a government funding measure. If Congress fails to reach a funding agreement by midnight, federal agencies will be forced to close, or partially close, at the start of the U.S. fiscal year on October 1.
"Shutdown or no shutdown, we're ready to go to start enrolling people tomorrow," Sebelius told reporters. "We're about to make some history, and I think some very positive history for lots of families in the country."
Republican U.S. Representative Charles Boustany of Louisiana, a leading critic of Obamacare, expressed misgivings ranging from the cost of coverage to the role of the Internal Revenue Service, a favorite target for conservatives that will help determine eligibility for health insurance subsidies.
"We know that the IRS is in the mix of this ... We know there are major problems there. I have really deep concerns about where this is going," he said on Fox News.
As many as 7 million Americans are expected to sign up for health coverage via the new exchanges for 2014. Another 8 million are expected to receive benefits through an expansion of the government's Medicaid program for the poor.
The Affordable Care Act, passed in 2010, requires that health insurance companies provide a basic package of benefits and prohibits them from excluding people due to prior illness. It provides billions of dollars in government subsidies, in the form of tax credits, to help individuals buy insurance on the basis of annual income. It also requires that all Americans obtain insurance, or pay a fine.
Republicans and other groups have fought the law for creating what they say is an intrusive government system to oversee healthcare that will place financial burdens on individuals and businesses.
EXCHANGES SET TO OPEN
Federally-operated healthcare exchanges in 36 states will go live at 8 a.m. (1200 GMT). Among the 14 states that will open their own exchanges, New York, Colorado, Oregon and some other states running their own exchanges plan to open at 8 a.m. local time, while others may open as early as midnight.
"It's a little hectic, as you can imagine. We've been a little overwhelmed," said José Calderón, president of the Hispanic Federation, a national organization that received government funds to help New Yorkers enroll. "It's going to be ACA (Affordable Care Act) all day and all night here."
Despite enthusiasm among reform advocates, however, the roll-out promises to be a rocky. Several exchanges, including Oregon, Colorado and the District of Columbia, have already said key functions for enrolling won't be in place in the first weeks of October.
Over the summer the Obama administration delayed numerous provisions of the law, most notably the requirement that large employers provide health insurance to their workers starting in 2014, as well as elements of the exchanges, such as their ability to sell policies to small employers and their workers and a Spanish version of the main website.
Software problems threaten opening-day glitches. Over the weekend, armies of information technology specialists tested and re-tested the complex interfaces and communication links needed to make the exchanges functional.
As opening day neared, many exchanges continued to ramp up education and marketing efforts. Kynect, Kentucky's exchange, handed out information at the Kentucky Bourbon Festival. Minnesota's exchange, as well as HHS, held live online chats to get the word out.
From insurance companies and hospital executives to policy experts and politicians, there will be intense focus on how the exchanges function, and how many customers they attract, from the opening bell. For weeks, however, the Obama administration as well as states have played down expectations for October 1.
"We are expecting a slight upturn of activity," Rebecca Lozano of the Portico Health Net, a Minnesota group that will help people enroll in coverage, said last week at an event hosted by Families USA, a non-profit that supports the ACA. "We're not imagining a run on the banks" on October 1.
"Those with preexisting conditions are the people we expect to be at the door when the door opens," said Reagan Hunt, executive director of Kentucky Voices for Health. "We have no idea what that number looks like."
Sebelius said on Monday that "the key date really is the 15th of December," the deadline for buying coverage that starts on January 1. "For millions of Americans, the new options are going to be affordable, within their own budgets. So January 1 can be a new day. It can begin to change the statistics where we will no longer have a large population in this country who doesn't have access to the best medical care."