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Obamacare off to good start, but success requires effort

This image provided by Illinois Gov. PQuinn's office shows logo brname thofficials unveiled Wednesday Sept. 25 2013 for new health

This image provided by Illinois Gov. Pat Quinn's office shows the logo and brand name that officials unveiled Wednesday, Sept. 25, 2013, for the new health insurance marketplace set to open Tuesday, Oct. 1, 2013. The brand and logo are part of a multimillion-dollar ad campaign beginning Tuesday and building through the fall and winter. Uninsured Illinoisans have until the end of March to buy health insurance through Get Covered Illinois. (AP Photo/Gov. Pat Quinn's office)

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Updated: October 28, 2013 6:44AM

The news on health care reform this week is that insurance premiums will generally be lower than budget experts originally predicted.

That’s good to hear, though Americans continue to wait for the details of so many other crucial elements of Obamacare, such as prescription costs, co-pays and deductibles.

Premiums, which critics warned would go through the roof, clearly will not, and Sen. Ted Cruz really should calm down and get a little sleep.

Obamacare may need tweaking, just as Medicare needed tweaking, but it’s looking good.

Illinois’ version of Obamacare, dubbed “Get Covered Illinois” on Wednesday, will go into operation Tuesday. An estimated 1 million residents of Illinois who now have no health insurance will have a lot of homework to do as they check rates, cost-sharing and whether doctors and nearby hospitals are in available networks.

Much of the news in Washington Wednesday was a distraction. Cruz, the Tea Party Republican from Texas, ended his all-night anti-Obamacare talkathon after 21 hours and 19 minutes, and congressional Republicans continued an effort to derail Obamacare through the threat of a government shutdown.

People who already have health insurance don’t have to pay much attention to all this. Under Obamacare, nothing need change for them. But that’s hardly the case for the uninsured. Get Covered Illinois is the biggest new social service program in the state’s history, and not everything will go smoothly at first, which puts more responsibility on the shoulders of ordinary citizens.

Starting Tuesday, an estimated 342,000 people will be eligible for the first time to enroll in Medicaid. Another 158,000 or so already are eligible but never signed up. The state is launching a marketing campaign to persuade those people to enroll in Medicaid, which is being redesigned as a managed care system.

The other half-million residents of Illinois who now lack health insurance will be able to sign up through a new insurance exchange that’s a partnership between the federal government and Illinois. The exchange divides the state into 13 rating areas, each of which offers a number of plans. Plans will be rated “bronze,” “silver, “gold” and “platinum,” with bronze offering the lowest premiums but covering only 60 percent of total costs. Platinum will have the highest premiums and cover 90 percent of costs. State officials expect most people to opt for bronze or silver plans. A bronze plan consumer in Chicago would pay $120 a month.

All plans are required to provide 10 “essential benefits”: ambulatory patient services; emergency services; hospitalization, maternity and newborn care; mental health/substance use disorder services; prescription drugs; rehabilitative/habilitative services and devices; laboratory services; preventive and wellness services and chronic disease management, and pediatric services, including oral and vision care.

Some states have been running campaigns all summer to educate people about the changes. But because the Legislature didn’t authorize a separate Illinois exchange, the state didn’t get funding for marketing until eight weeks ago, which is late in the game. Now, state officials are rushing to get the word out.

Illinois has set up a website using upgraded technology and has trained counselors to create “one-stop shops,” where people can go to learn details about various plans and which they qualify for. Deputy Illinois Gov. Cristal Thomas says the state is trying to create a “culture of coverage” by encouraging people to sign up during the six-month enrollment period.

Other than undocumented individuals, who don’t qualify for ObamaCare, officials expect the biggest resistance from people put off by the cost of health insurance. Others will be deterred because they are confused and some complacent “young immortals” will resist enrolling because they don’t think they need insurance. Those who don’t enroll will pay a first-year penalty on their income tax bill of $95 for individual or 1 percent of their income, whichever is greater.

Sliding-scale subsidies will help people who earn from 138 percent up to 400 percent of the federal poverty level pay for the premiums. For example, a family of two parents and two children in Chicago with a household income of $60,000 could be eligible for a subsidy that would set their monthly cost at $234.

Obamacare appears to be off to a good start, but it will take effort from everyone involved to make it work in the long run.

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