Exchanges will help millions, but big questions remain: Our View

Your view of Obamacare's reforms will depend on where you sit.

3:49 PM, Sep. 30, 2013  |  Comments
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Today is not the first day of Obamacare. Some provisions of the law have been in effect for years; others won't take effect until next year or later. But today is a significant day for the health care reform law, and there has been an intense and understandable focus around the opening for millions of Americans of the online health insurance marketplace at Some of the people who will be seeking insurance today, including a portion of Wisconsin's 11.3 percent uninsured, will be doing so for the first time ever.

What does this mean? Well, the unsatisfactory answer is that it is going to mean very different things for different people. In fact, if we have learned anything from the years of debate about the health care overhaul - before, during and after passage of the law - it is that the issue is intensely personal and emotionally charged. Your view of what the health care system needs is colored by your experiences, your anxieties, your own needs.

In its weekend report, Gannett Wisconsin Media's Investigative Team considered the law through the eyes of a number of different people, each with a unique perspective. It is clearly not a comprehensive list of viewpoints, but each one of us should consider the scope of what we talk about when we talk about health care:

? Ken Heiman, 60, of Marshfield, a co-owner at Nasonville Dairy, is understandably concerned about the cost of providing insurance for his 100 employees. He has resisted cutting back on employees' hours or canceling insurance coverage for workers at his farm, but he is waiting, concerned, to see how his insurance premiums might change - and how his business will adapt.

? Rosie Thiel, 51, of Shawano is one of the people who will lose access to BadgerCare under Gov. Scott Walker's plan to move many low-income families onto the exchanges. That means she will be shopping today for a private insurance plan that meets her needs and that she can afford.

? Alex Bowlby, 23, of Fond du Lac, is the sort of young person who often would have gone without insurance prior to the law - and he's an example of the risks of that. The otherwise healthy Bowlby had a blood clot in his lung in 2012. Because he was covered by his mother's health insurance plan under a provision in Obamacare, he escaped tens of thousands of dollars in medical debt.

For many of those who had been uninsured, the coverage they receive on the exchanges that open today - after the glitches, hassles, delays - are going to provide them some security they have not had before. For some who are losing BadgerCare coverage, the exchanges represent an unwelcome uncertainty they wished to avoid.

And for others, including the majority of those middle class households who still receive benefits from their employers, the wait continues. Will premiums increase? How will employers react? What effect will the creation of the exchanges have on the broader marketplace?

Some of the indications are good: Health care costs in the 12-month period that ended in May rose at a rate of 1.1 percent, according to the White House Council of Economic Advisers. That was the lowest rate of increase in 50 years. That is a big deal, but we still don't know to what extent it will be reflected in actual insurance premiums.

Here's what we know: There are a lot of people who are working very hard to make the exchanges that open today work. Whether they will change things for the better probably is going to depend a lot on your perspective.

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