Mobility and familiarity

The multiple provisions of the Affordable Care Act, which will take a big step forward Tuesday with the easier availability of insurance plans for the uninsured, offer plenty of opportunity for confusion, uncertainty and derision. Having the federal government mandate insurance with minimum levels of coverage, while taxing the wealthy (and medical equipment manufacturers, for one) to generate revenue to subsidize those who cannot afford their insurance premium and establishing state and federal bureaucracies to operate it all, makes that possible. The ACA is a very, very big target.

The Affordable Care Act is a landslide change in the way Americans cover their health-care costs with the financial protections that come from having insurance. And while the multitude of plans will make it possible to more closely match coverage with needs and thus reduce insurance costs, contrary to its title, the ACA will not significantly reduce the cost of the underlying medical care. That will have to come another day, in other ways.

Two aspects of the Affordable Care Act are appealing.

What the ACA is beginning is the ability to detach health insurance from the workplace. Currently, large companies almost always have more thorough and generous health-care plans than do medium-sized and small employers. Those in the small employer category may not offer company-based insurance.

This is a country of small businesses. Those owners and employees ought to have coverage that is as good as, or almost as good as, those working for brand-name companies. The state insurance exchanges for the uninsured, or the private exchanges for company employees, will help make that possible.

Personally held insurance also eliminates a major reluctance to move from company to company to better match job skills, to live near family or for better pay. Work ought to be what you want to do, where you want. Insurance coverage, or the lack of it, should not impede that.

In the headlines are a few large companies that are closing down their company-organized insurance plans in favor of providing their employees with a stipend to purchase their own insurance now that a large choice in plans is possible. Over time, that is not a negative. Along with the numbers of currently uninsured who will soon have coverage, those who will go to exchanges to choose their own coverage will begin to tip the balance of benefits away from the large companies.

There are also those who want more personal responsibility to play into health-care coverage, and rightly so. We know what greatly increases the chance for good health – a proper diet and exercise and not smoking – yet many Americans choose to ignore the obvious. We do not believe that becoming familiar enough with individual insurance plans under the ACA will encourage everyone to be fit, but it will be a step in that direction. While some companies include techniques to encourage wellness, for many employees, there is a disconnect between their insurance plan and their life choices. Knowing to some extent your own plan ought to lead to behavior better suited to good health.

As we have said before, the Affordable Care Act does not cure what is wrong with health-care financing or certainly delivery. But it does set that challenge on a new and very different track, one that with adjustments ought to better serve Americans. Oct. 1, with the availability of the health insurance exchanges for the uninsured, is a very significant step in that direction.

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