8. Could people enroll by the Dec. 23 deadline but be told by doctors or hospitals next year they donít have insurance?
That is one of the biggest worries right now. CMS officials are advising consumers to check with their new insurers to confirm coverage, particularly if they havenít received their insurance cards. No one wants a situation in which consumers try to get medical care and are turned away by a hospital or doctorís staff or, if they do succeed in getting care, later learn that the treatments were not covered.
The timing is extremely tight. People have until Dec. 23 to enroll and until Dec. 31 to pay their premiums for coverage thatís supposed to start on Jan. 1.
9. If fewer people than expected are insured, doesnít that mean the health care law is bound to fail?
The Congressional Budget Office estimated that 7 million people would enroll in the federal and state marketplaces by March 31, 2014. The CBO predicted another 9 million would sign up throughout 2014 for the low-income program Medicaid. So far, neither outcome is guaranteed, and the marketplace enrollment is likely to fall way short.
If enrollment isnít as strong as predicted, insurers could jack up their premiums in 2015. If that happens, there may be fewer healthy people next fall willing to pay premiums that subsidize sicker people. That could lead to a cycle in which the pool of people buying coverage will become increasingly sick and costly to cover.
But that worst-case scenario overlooks a few points.
First, some analysts say the most crucial factor is not how many people sign up, but how healthy those enrollees are. Healthy people may not abandon the system, in part because federal subsidies will keep costs relatively reasonable for lower-income people, many of whom are young, and because the law requires most Americans to buy coverage.
Insurers may not want to hike premiums dramatically in 2015, because itís in their interest to entice people to buy their products. And insurers have training wheels for the first three years, anyway, because the federal government is covering the costs of many of the sickest patients and capping insurersí losses. So if the first yearís enrollment data arenít impressive, it doesnít necessarily mean the death of the program. But a Zients-like replacement is likely needed to get it in shape.