The US government has shut down in a row over the health care law which comes into effect. Source: AAP
MILLIONS of Americans will be able to shop for the first time on the insurance marketplaces that are at the heart of President Barack Obama's health care reforms.
They are entering a world that is supposed to simplify the mysteries of health coverage but could end up making it even more confusing, at least initially.
Whether consumers will be pleased with the experience, the premiums and the out-of-pocket costs of the plans offered to them will finally start to become clear.
Tuesday's rollout comes after months of build-up in which the marketplaces, also known as exchanges, have been both praised and vilified.
Illustrating the heated political disagreements over the law, the opening of the exchanges comes the same day as the shutdown of the federal government, led by congressional Republicans who want to block the health insurance reforms from taking effect.
The shutdown will have no immediate effect on the insurance marketplaces that are the backbone of the law, because they operate with money that isn't subject to the annual budget wrangling in Washington.
The marketplaces opening in all 50 states represent a turning point in the US approach to health care, the biggest expansion in coverage in nearly 50 years.
The Obama administration hopes to sign up seven million people during the first year and has a goal of eventually signing up at least half of the nearly 50 million uninsured Americans.
But if people become frustrated with predicted glitches in the computer-based enrolment process and turn away from the program, the prospects for Obama's signature domestic policy achievement could dim.
"The promise of the law is that no one will go bankrupt because of medical bills," said Neera Tanden, president of the Center for American Progress, which helped work for passage of the law. "It won't happen in the first day or the first year. But when the law is fully operational, it will provide an economic benefit to roughly 30 million Americans."
Tanden cautioned against rushing to judge the marketplace's success on its first-day performance.
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