Now that the extended, extended deadline to enroll in health insurance plans has passed (except for those who got the "absolute" last extension by simply entering their names on the healthcare.gov website--when it was working yesterday) what comes next? Well believe it or not, this is where actual hard work begins. Up until now, all we've been doing is trying to convince people to buy something they either didn't want or didn't want unless it was free. From here on out, all of the effort will go into keeping the system from imploding upon itself.
Let's start with collecting the penalty--I mean tax (for constitutionality purposes)--from those who failed to meet the extended, extended deadline to enroll. While some steadfastly refused to join in for political reasons, most of the "scofflaws" likely aren't paying any income taxes anyway--so how is the IRS going to collect the "onerous" $95 fee? And how many agents will be dedicated to checking to make sure that the policies filers claim to have on their 1040's next year are actually active?
Then let's move to making sure that all of those young, healthy people that are the key to keeping the policies in the federal exchange "affordable" (with government subsidies) don't actually use the policies they were just made to purchase. The "invincibles" are cheap to insure because they don't go to the doctor. But that doesn't hold true anymore if all those 20 and 30-somethings decide to get their money's worth--instead of just being "subsidizers". We should expect daily tweets from the White House Press Secretary Jay Carney and Hollywood celebrities reminding everyone to "buckle up when you drive today--we don't want you to get hurt in an accident!" We should also start running public service announcements telling young adults to give up mountain biking, wind-surfing, contact sports weightlifting because "you might get hurt and need to see a doctor!"
Our next challenge is to get everybody else to actually use what they just bought, properly. Just because women of any age (and men) can get free birth control pills doesn't mean they are going to take them every day so they work. We are talking about people who "forgot" to sign up for insurance until the last minute of the last day. Maybe First Lady Michelle Obama can create another viral internet video with LeBron James asking those ladies "Have you taken your pill today?" We also need to ride the Type II diabetics to put down the junk food, and the folks with the high cholesterol to bypass KFC and the drunks to stop drinking and the smokers to stop smoking and the drug users to stop using (except for potheads, of course--because marijuana is medicinal and good for you, man), and the mothers to give their kids carrots instead of Cheetos and couch potatoes to actually go for a walk around the block every few days. Otherwise, having this "blessing" of mandated health insurance isn't going to do them a lick of good. (Or lower the costs of health care).
And finally, health care providers now have to adapt to their new "customer base". 30-million people "desperate" to see the doctor now can (not that they were barred from doing so before). Unfortunately, we don't have a glut of health care professionals in the market right now--in fact we are quite short at pretty much all positions (except cosmetic surgery). So somehow coming up with more hospital and clinic staff out of nowhere suddenly becomes a priority. And many of these new patients are the same people that we are told can't make it to to polls on Election Day between 7:00 am and 8:00 pm every two or four years--so how can you expect them make it to appointments during "regular" clinic hours?
If you thought it was tough just getting the Affordable Care Act off the ground, just wait until you see the effort (and expense) put into keeping it from crashing into a giant atomic mushroom cloud.