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Three Reminders that Obamacare Still Isn't Hunky-Dory

Getty Images: Joe Raedle

Obamacare has been getting better press lately, and rightly so. More people keep enrolling and, better still, more people are taking advantage of the law's benefits. But not everything is hunky-dory, as three new stories make very clear.

Story one is about people who signed up for insurance and are trying to use it. Some are showing up at drugstores, physician offices, and hospitals—only to discover that insurers don’t have records of their enrollments. A New York Times story, by Robert Pear and Abby Goodnough, reports on a few such stories, including at least two in which people have delayed getting care because insurers weren’t prepared to pay their bills.

Story two is about whether people signing up for insurance are paying their premiums. Significant fractions are not. You can read about this in the Wall Street Journal, where Anne Wilde Matthews and Christopher Weaver interviewed officials from several insurers. In their sample, the carriers were seeing premiums from about two-thirds of the people who signed up for coverage.

Story three is about small businesses and changes coming to their insurers. Most small businesses have renewed existing policies, rather than opt for new ones. But next year they won’t have that option—and many will have to give up current plans, just like so many people buying coverage on their own. The story will play out the same way, with some better off and some worse off. But that means more disruption before 2014 is done. Ariana Eunjung Cha of the Washington Post has a lengthy and well-reported story about that.

None of these stories are likely to dominate the news the way plan cancellations and website problems did in October and November—and not just because the media is a lot more obsessed with Chris Christie right now. The public is getting a little bored with the whole controversy and none of these particular problems seem to represent an existential threat to the law.

Remember, confusion over insurance arrangements is pretty typical for January, because that’s when employer plans switch over and lots of people are using policies for the first time. The scale of the problem may be bigger than usual, because of the people signing up for Obamacare and the errors in data that government websites were sending to insurers. But it’s a problem that health care providers and insurers are accustomed to handling at this time of year. And it's not even clear how widespread the problem is.

The percentage of people paying premiums is bound to go up over time, as people realize their insurance is no good until they pay—and as insurers work their way through backlogged registrations and payments. As for small businesses, the changes they see will, on the whole, be far less significant than the ones people buying coverage on their own saw. That’s because small business coverage in most states was already subject to a lot of regulation: The new market simply isn’t that different. Larry Levitt, senior vice president of the Kaiser Family Foundation, had a series of tweets about this over the weekend.

Still, there's no way to be sure these problems won't get worse. And even if they don't, these issues are a reminder that the Affordable Care Act is very much a work in progress. The health insurance market is undergoing a major transformation, one that—in my view, certainly—will leave the country better off. Stories like a testimonial from Anna Clark, a Detroit-based freelancer who finally has insurance, are a reminder of that.

But this is a compiicated process, one sure to generate some bad news along with the good—for months and probably for years.