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JAMA Forum

The End of the Beginning for the Affordable Care Act

It’s now halftime for the launch of the Affordable Care Act (ACA). People seeking coverage to begin on January 1 had to enroll between October 1 and the end of 2013, but they can continue enrolling until March 31, when the open enrollment period for 2014 ends. As Winston Churchill might have described it, it’s the “end of the beginning.”

The first half of the open enrollment period was not for the faint of heart. As I wrote in the JAMA Forum last February:

Until now, both benefits and risks of the law have been hypothetical. But soon we will have real experience, and it is very likely that it will be less than perfect. As the CBO [Congressional Budget Office] has projected, enrollment may be modest at first. There also will undoubtedly be technical glitches in the eligibility and enrollment systems that are being created from scratch on a tight schedule. Some people will see their premiums increase, and anecdotes about those cases will undoubtedly be highlighted in the media. The fact that others will see their costs decrease or will have insurance that offers better benefits and more secure coverage may be overlooked. Although personal out-of-pocket costs for health care should decrease for most people, some may nonetheless perceive their deductibles and co-pays as unaffordable.

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