1) 20 years is too long to figure out that it is time for a different approach. The National Task Force on Healthcare Reform, which Hillary Clinton headed, convened in 1993. The Republicans revolted in 1994. Fast track 20 years to October, 2013 when House Republicans tried to shut down the government in hopes of an outright repeal of Obamacare, now law. If our goal is to improve access and bring down spiraling costs, we need to work together.  

2) According to MSNBC today, HHS just released figures showing 106,000 people have signed up for the Affordable Care Act. For now, 15% or 48 million Americans remain uninsured. 

3) 4.8 million have had their policies cancelled, according to Forbes.com. Many of them are middle class folks who were happy with their plans. They were told they would get to keep their policies if they liked them. But now, the government is talking about offering them a “premium boost” funded by taxpayers. Remember the Harry and Louise ads about that befuddled middle class couple who thought their options under the reworked federal health insurance plan were too complex. Turns out they might be. 

4)  Some states are having more success with their exchanges than others. Connecticut has signed up more customers than any other state. Oregon hasn’t signed up 1. Both were among the 14 states plus Washington, DC that decided to run all aspects of their exchanges. 

5) States have the option to implement the exchanges in ways they see fit. Utah decided to serve small businesses while leaving individual coverage to the Feds. Idaho and New Mexico opted to use the Feds’ information technology infrastructure (navigators, websites and call centers) while managing the actual healthcare coverage themselves.  

6) Experts from Kaiser Family Foundation estimated that Americans would be divided between applying for private health insurance through the exchanges or defaulting to Medicaid. According to news reports, in some places, 9 out of 10 enrollees have opted for Medicaid instead of buying private insurance.

7) The current crisis isn’t over a faulty website. It is where the money is going to come from for all those new Medicaid patients. The Feds offered to pay for it through 2016 but that was based on healthy people signing up for Obamacare to offset the addition of lower income citizens with few options, like uninsured children, those with pre-existing conditions and the disabled.