WASHINGTON — Last month, a political group aligned with House Republicans sent an email to reporters attacking the new health care law.
“Young adults on parents' plan pay more,” the message from the YG Network said, citing a new report. “So much for popularity.”
Actually, the report did not say that those young adults were paying more. It said that insurance companies were paying more because they had begun providing coverage to those young adults, as called for under the new law.
The email, inaccurate and sneering as it was, illustrates the huge challenge facing the Obama administration as it puts in place the most important parts of the 2010 law during the rest of this year. Few government programs reach so many corners of U.S. society and have so much potential to stir up trouble for the Democratic Party, which holds the White House.
Among the complicated tasks that await: pushing reluctant states to set up insurance marketplaces and to expand Medicaid programs, keeping an eye on insurance companies as they set new rates, measuring the law's effects on small-business hiring and coaxing healthy young people to buy coverage, as they're supposed to, so the system works economically for everyone.
Economist Gail Wilensky, who ran Medicare and Medicaid under President George H.W. Bush and who supports the new law, said that 2014, when the law's requirement to have insurance begins, “is going to be quite a bumpy year.”
Austan Goolsbee, former chief economist to President Barack Obama, predicted “a big messaging headache the whole year.”
The law may pose modest headaches for the overall economy as well.
It requires, for example, that businesses with 50 or more full-time workers either offer insurance coverage or pay a penalty.
Goolsbee said he would be watching to see if companies near that threshold defer hiring or shift some full-time workers to part-time employment.
But the number of such companies is small. The vast majority of U.S. workers are employed by larger companies that already offer health coverage.
Some young people will see a significant increase in their health costs, said Karen Ignagni, who leads a health insurance trade group. That's because the law will require them to buy more coverage than many of them now have.
But that will be offset by subsidies available to lower-income customers and, for women, by rules barring insurers from charging women more than men.
The law's supporters predict that workers with better health care will be more productive. And the expansion may ease the “job lock” that some workers say prevents them from seeking better employment for fear of losing health insurance.
Throughout 2012, uncertainty over the law's future hung over employers and investors. “It impeded the recovery,” said economist Mark Zandi.
But in June, the U.S. Supreme Court upheld the core of the law, and in November, Obama won re-election. Going forward, Zandi said, “it's prudent at this point to think it's all going to be a wash” economically.
However, that won't ease the hurdles that the administration must clear to put the program in place.
Fewer than half the states have said they plan to establish their own health care marketplaces, or “exchanges,” where people can sign up for coverage. Washington must step in for states that decline to do so, among them Nebraska. Iowa has received approval for a state-federal partnership exchange.
Also, only about half the states have indicated that they will expand Medicaid under the law. Expanding that federal-state program is the main way of getting coverage to uninsured low-income Americans, but the reluctant states — including Nebraska and Iowa — say they are leery of the long-term costs and are exploring alternatives.
Some newly insured people may have trouble finding treatment because of a shortage of doctors and because some state “scope of practice” laws bar others, such as nurse practitioners, from stepping in.
The most challenging hurdle of all: persuading young, healthy Americans — the most profitable customers for insurance companies — to buy the required coverage, even though the penalty for not doing so is a modest $95.
White House officials say the group's participation is vital because it would offset the cost of less-healthy customers.
Beyond those challenges is the long, bitter debate over health care that has taken place in the nation's polarized political culture. White House strategists estimate that 9 in 10 Americans have fixed views one way or the other and will be moved only by personal experience with the new law.
Yet the critics don't intend to let up, especially as the 2014 midterm elections draw closer.
Ian Prior, a spokesman for the House Republicans' campaign committee, vowed that his party's candidates would keep hammering away at Democrats who voted for the law.