We are now at an important contingent moment in American social policy -- the Obama Administration will be issuing thousands of new rules to guide the ACA's implementation and these rules will either benefit sick people or the mega-profit insurance industry.
Here are some areas, in no particular order, where we will need to -- as progressives -- keep the heat on the administration:
1.) Preserving subsidies and the Medicaid expansion in the face of so-called 'fiscal cliff' negotiations.
2.) Nudging petulant Red states to expand Medicaid given the Supreme Court eliminating the Federal Government's coercive powers.
3.) Ensuring that the government-mandated package of benefits offered with exchange-based plans are as robust and generous as possible -- AHIP -- the health insurance lobbying organization -- has been pushing hard to make new plans as stingy as possible.
4.) Ensuring that the multi-state, non-profit, federally-sponsored plan is as robust as possible to take market share -- and healthy patients -- away from the mega-profit insurers. (Doing this would put commercial insurers in a 'death spiral' of sorts, which could hasten the arrival of a true public option.)
5.) Making the implementation of the mandate as pro-patient as possible. This is absolutely crucial. Insurers will push an incredibly draconian mandate to ensure as many healthy people as possible are compelled to buy their defective products. Ideally, Obama Administration rules will truly allow individuals to buy insurance at any time of the year. Insurers, though, would probably like to see small open enrollment windows and severe financial penalties for those who need to acquire coverage outside of those windows.
6.) Maximum portability between plans at any point of the year. If the bastards at Aetna make filing claims too difficult, you should be able to switch plans at any time of the year without any lapse in coverage or financial penalty. Otherwise, patients will be trapped with crappy insurers just like they are now crapped on wireless phone plans with horrible carriers. In other words, you should be able to go from Verizon to AT&T and then to T-Mobile if that is what you want -- as easily as possible.
7.) Because of this Byzantine system, some individuals will go from qualifying for Medicaid to qualifying for subsidies -- or vice versa -- frequently within the course of a year. Negotiating these eligibility challenges can either happen in a manner that is pro-insurer (i.e. making it hard to get back on Medicaid) or pro-patient (i.e. ensuring coverage is constant, without any gaps and that doctor choice is preserved).
8.) Making it clear to mega-profit insurers that they will be severely punished and shamed for unjustified rate increases, poor customer service, lack of doctor choice, and denial of care.
9.) The ACA allows the maximum cap on deductibles to increase every year. Good policy will not allow this to happen -- particularly when wages are stagnant. Insurers should be severely disciplined regarding any deductible increases.
Other thoughts? Let's keep the discussion going.