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Obamacare's full implications only now becoming clear

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By James McCusker
Published:
Obamacare began its life as the "Patient Protection and Affordable Care Act" and that is still its legal, if rarely used, name.
As Obamacare gets closer to maturity both its economics and the full flowering of its administrative apparatus emerge from the smoke and fog of its origins. One example is in the release by the U.S. Department of Health and Human Services of its proposed "Standards for Navigators and Non-Navigator Assistance Personnel."
The original, 2,700-page Obamacare law is a tough read, and people are still discovering provisions, requirements, taxes and fees that had been obscured by the complex structure and the sheer volume of words. Last week's 63-page HHS proposal could not hope to top the energy-sapping prose of its parent law, but it is competitive.
Our medical care system is very complex and we would expect that a major reformation of it would be complicated also. The idea that we all will need "Navigators" has both ominous and comical aspects to it, but at least somebody was thinking ahead to how difficult Obamacare will be to implement and maintain.
Private sector navigational tools are already beginning to show up in the market. The most heavily marketed book about surviving Obamacare is now number nine on Amazon's top sellers list -- recently overtaking a book about zombies and now gaining on Gwyneth Paltrow's latest collection of recipes.
Books are only part of solving the navigational problem, of course, and there is little doubt that eventually web sites, computer programs and smartphone apps will pop up to help people figure out where the heck they are in this new health care system. Unfortunately, these navigational aids will also present near-endless opportunities for money scams and phishing-related identity theft.
At this point, however, the development of navigational aids is handicapped by not knowing what the "exchanges" required by Obamacare will look like, how they will function, or what hazards for consumers there might be in making a wrong choice.
The unknowns about the exchanges have been multiplied by expansion of their types and definitions. Within this small HHS proposal on rules, for example, there are at least four different kinds of health care exchanges envisioned and defined, and more are probably coming.
What the HHS proposed rules do cover are conflict of interest issues, qualifications, certifications and suggested pay for the newly imagined and defined "Navigators" who are from the government and will help people find their way through the corn-stalk maze of Qualified Healthcare Plans under Obamacare.
When we hear the term "Navigator" we usually think of a person, but that is not necessarily the case. One of the principal functions of the newly defined navigators will be to apply for and receive federal grant money, a process in which organizations clearly have an edge over individuals.
Obamacare amplifies this edge, and the proposed HHS rules cite the law in which Health Insurance Exchanges are required, "to select at least two different types of entities as Navigators, one of which must be a community and consumer-focused non-profit group." In other words, every exchange has to include a community action group.
Along with the Navigators, the new rules will cover "Non-Navigator Assistants," who apparently will be real people, not organizations. Their job will be to help people navigate the system and select the coverage that best fits them. By the time we get to the non-navigators, though, the full weight of the bureaucratic language begins to be felt. Picture yourself explaining your question to someone whose official-looking shirt identifies him or her as a, "Non-Navigator entity or individual authorized to carry out consumer assistance functions under Sub-Section 155.205; (d) and (e)."
Language aside, the proposed rules begin to reveal how Obamacare will relate to the private sector portion of our health care system, and especially to the private insurers who now provide coverage to millions of employees and individuals across the country.
Insurance companies are not the most widely loved institutions in America but their worries on this count will soon be over. The community action groups that are a required part of Obamacare insurance exchanges have, in the past, displayed little interest in the reality of health care economics. Hospitals, doctors and health care insurance companies are viewed, at best, as financial pinatas to be whacked. At worst, they are viewed as the enemy.
The Affordable Care Act was passed by Congress before minority members or the public had an opportunity to read it. It is being read now, though, and what it says is that private sector health care as we now know it will disappear. The only things missing are a blindfold and a last cigarette (declined, of course for health reasons). It's that simple.
James McCusker is a Bothell economist, educator and consultant. He also writes a monthly column for the Herald Business Journal.

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