The federal government shut down at 12:01 a.m., Tuesday, after Congress failed to reach a budget compromise, with Republicans tying any funding deal to an attempt to defund the Patient Protection and Affordable Care Act. Despite the shutdown, enrollment for Kentucky’s online health insurance exchange, Kynect, began Tuesday as scheduled.
The shutdown drama is heightened since Tuesday is both the start of the federal fiscal year and the first health insurance can be bought on the online exchanges created by the reform law, often called Obamacare. Kynect won’t be affected because it is funded by a “permanent appropriation,” that isn’t subject to annual appropriation, Paul Van de Water, a policy analyst at the Center on Budget and Policy Priorities, told Sharon Begley of Reuters.
The Department of Health and Human Services’ contingency plan for a government shutdown makes clear that Obamacare will continue, along with other mandatory programs like Medicaid and Medicare, programs that do not rely on annual appropriations and involve the human life and safety, Cunningham and Nather report. “And that means the staff that carry out mandatory programs like those in the health law can keep working — even if their positions are funded through the annual spending bills.”
However, uncertainty about the shutdown could add more confusion to America’s lack of understanding of the health law. Many may not realize they can sign up for coverage through the state exchanges even if the federal government is shut down.
The Kaiser Family Foundation’s August 2013 Health Tracking Poll showed that roughly four in 10 Americans, 44 percent, either think the law has been repealed by Congress or overturned by the Supreme Court. A recent Pew Research Center poll last week found 53 percent of Americans disapprove of the law, and 42 percent approve.
But most Americans oppose defunding the new law if it means shutting down the government and defaulting on debt, says CNBC’s third quarter All-American Economic Survey.
President Obama has said he will not negotiate on his signature legislative accomplishment, and most Senate Republicans have disavowed the House Republican strategy of risking a government shutdown.
The stakes are high for both political parties, writes Noam Levey of the Los Angeles Times. For Democrats, a meltdown of the new system would be politically damaging. For Republicans, “A relatively drama-free rollout of the law this fall could shatter what has been a key pillar of the Republican agenda.”
Opinions about Obamacare will not change overnight and the law’s effectiveness won’t be determined by the first few weeks of the exchanges. The Congressional Budget Office estimates that only about 7 million people will enroll in 2014, but that the number will rise to 25 million by 2018.
There are currently 640,000 uninsured Kentuckians, which 14.9 percent of the state’s population, says the Kynect website. About 332,000 will be able get insurance through the exchange, and 276,000 of them can get subsidies to buy insurance coverage through the exchange. An additional 308,000 Kentuckians will be newly eligible Medicaid, with expansion of the program to people earning up to 138 percent of the federal poverty level.
It is expected that about 147,000 Kentuckians who are newly eligible for Medicaid in 2014 will find coverage through Kynect. That number is projected to increase to about 188,000 by 2021, says a Medicaid expansion report. Open enrollment for coverage runs through March 31, 2014. Beginning Jan. 1, coverage purchased on the exchange will take effect, and most Americans will be required to have health insurance or pay a penalty.
Gov. Steve Beshear and Lt. Gov. Jerry Abramson are appearing at events across the state this week to promote the exchange and enrollment, starting Tuesday morning in Louisville and that afternoon in Hazard. They will visit Ashland, Lexington, Covington and Bowling Green on Wednesday; and Mayfield and Owensboro on Thursday.