WASHINGTON -- Four years ago, a law intended to extend prescription-drug coverage to millions of seniors temporarily had a reverse impact: Hundreds of thousands with government coverage couldn't get medicines or were overcharged because of computer glitches and confusion.
With the ink barely dry on this year's comprehensive health care law, the Obama administration and consumer and industry groups are readying education campaigns designed to stop history from repeating itself.
The private "Enroll America" campaign is aimed at making it easy for Americans who qualify for Medicaid or private insurance subsidies to sign up. It will raise money to hire local staffs, which will push state governments to create user-friendly enrollment systems. The goal is to allow people to sign up when they see a doctor or apply for other benefits, with simple applications printed in multiple languages.
That makes sense to Mark McClellan, who helped fix the Medicare drug program's early glitches in 2006 when he headed the Centers for Medicare and Medicaid Services. The program ran into trouble on day one when it tried to switch about 7 million seniors and people with disabilities from Medicaid to Medicare.
"That took some work to fix right around the start of the program," McClellan recalls. "There will unquestionably be bumps in the road on implementation."
The 10-year, $938 billion health care law includes $1 billion for that purpose -- far short of what will be needed, according to the Congressional Budget Office. The agency projects implementation costs at $10 billion to $20 billion, which would come from future appropriations.
The major tasks will fall to Secretary of Health and Human Services Kathleen Sebelius and Treasury Secretary Timothy Geithner. Changes to the insurance market to protect consumers will require new regulations. State-based health insurance "exchanges," or marketplaces, must be created. Medicaid must be greatly expanded. At the Internal Revenue Service, a new system of federal subsidies must be devised.
"I don't have optimism that this can or will happen smoothly," says former Utah governor Michael Leavitt, who led the Health and Human Services Department when the Medicare prescription-drug law went into effect. He says insurers may drop out of the market, and costs are likely to rise beyond projections.
The Obama administration has begun an education campaign. Sebelius conducted regional TV interviews Tuesday and Wednesday in seven states from Arizona to Pennsylvania. On Wednesday, she and Small Business Administrator Karen Mills kicked off what will be a weekly webcast on www.healthreform.gov, where consumers' questions will be answered.
The "Enroll America" campaign is headed up by Ron Pollack, executive director of the health consumer group Families USA. He plans a multiyear effort involving doctors, hospitals, drugmakers and others who supported the law, as well as opponents such as health insurers.
Among the partners: America's Health Insurance Plans, a trade group that opposed the law. "It's in everybody's interest that people get coverage that they're eligible for," the group's Robert Zirkelbach says.
Jim Firman, president of the National Council on Aging, led a similar outreach effort in 2006 to sign up low-income seniors who were eligible for subsidies. Yet even now, the council says only 63% of eligible seniors get the subsidies.
All those involved in that effort say the key is to reach people with basic facts about what the new law means to them. "What made this work was the groups in church basements and shopping malls, children helping their parents do it," Leavitt says.
The prescription-drug law was passed in the fall of 2003, giving the Bush administration about two years before it went into full effect in January 2006. Even so, glitches dominated the early months of the program. Seniors had trouble choosing from as many as 52 insurance plans offered in various states. The administration eventually simplified the menu of plans and reimbursed states for providing emergency assistance.
By midyear, thousands of seniors had a gap in coverage, known as the "doughnut hole," that left them paying the full cost of their medicines. The new law is designed to close that coverage gap over 10 years.
Parts of the new law will go into effect later this year, but the major elements, including a mandate that everyone get insurance and the state exchanges, are delayed until 2014.
"One of the things they clearly learned was to give themselves more time," Firman says of the new law.
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