DAVID GREENE, HOST:
Today marks an important milestone in the implementation of the Affordable Care Act. It's the launch of online marketplaces, called exchanges, to help people find insurance they can afford.
STEVE INSKEEP, HOST:
And just to repeat, the exchanges go forward even if the government shuts down. Exchanges are an idea pioneered by Massachusetts seven years ago. NPR's Richard Knox reports that residents there call the program a success and that the exchange was an indispensable factor.
RICHARD KNOX, BYLINE: Massachusetts' health insurance exchange is called the Connector. It was the brainchild of former Governor Mitt Romney, a Republican. Glen Shor once ran the Connector. He is now the state's secretary of administration and finance and he is confident the nation will follow Massachusetts' lead.
GLEN SHOR: As the law begins to be implemented, people will see and feel its positive effects. They'll be able to see through some of the rhetoric and spin.
KNOX: Shor says there was widespread thirst for coverage in Massachusetts. Once the Connector opened for business, people signed up much faster than anyone expected.
SHOR: Enrollment was fast. One of the clear lessons of the Massachusetts experience is that people want affordable health insurance.
KNOX: And today, 97 percent of the state's population have it, the highest of anywhere in America. Shor says Obamacare will increase that; 45,000 people working in low-wage jobs will qualify for the Massachusetts Medicaid program.
SHOR: Roughly a quarter of the remaining uninsured. That would be a big deal.
KNOX: Thousands more will become eligible for premium subsidies through the Affordable Care Act because they make under $46,000 for an individual and $94,000 for a family of four. That will bring Massachusetts pretty close to advocates' longtime dream of universal coverage.
SHOR: It's a fight that's worth fighting and I think ultimately it will be won.
KNOX: But not everybody in Massachusetts is quite so optimistic. Rick Lord is president of Associated Industries of Massachusetts, a prominent business group. He was also a leader in the broad coalition that resulted in what some people here still call Romneycare.
RICK LORD: I think Massachusetts got health care reform right.
KNOX: But Lord points out that anything as complicated as health care reform is going to need some tinkering along the way. In Massachusetts the legislature passed without controversy three technical corrections as the health law got implemented. Lord doesn't see how Congress can do that with Obamacare.
LORD: No amendment to the Affordable Care Act will be passed for fear that the whole act will unravel.
KNOX: That makes him more than a little worried.
LORD: I'm feeling a little pessimistic about how it's going to play out in Washington. You know, if it's not successful at all, I worry that that will doom the prospects for revisiting this in the short term.
KNOX: Or even the medium.
LORD: Right, in the medium.
KNOX: But for now the fate of Obamacare depends on whether enough Americans vote with their feet in the coming three months.
BRIAN ROSMAN: That's the big question.
KNOX: Brian Rosman is research director of Health Care for All, Massachusetts' leading health consumer group.
ROSMAN: Will people jump over the negative publicity and go out and seek health care for themselves because it's in their interest? Our experience in Massachusetts is that they're going to sign up.
KNOX: Kate Bicego thinks people across the country will too.
KATE BICEGO: I am the consumer assistance program manager at Health Care for All.
KNOX: Bicego has been getting a lot of calls from officials in other states who are scrambling to set up exchanges and from consumers outside Massachusetts. She's heard just about every question, worry and rant about the new exchanges.
BICEGO: People don't know what Obamacare is. Most people have filled their heads with a lot of misinformation about what the law actually requires of people and what the law offers.
KNOX: Bicego thinks there's only so much anybody can do in advance to dispel the misconceptions. It's only when people can get their hands on information that matters to them that proponents can cut through the confusion.
BICEGO: You don't message about the benefits of something until you can access them. If you had been talking about that in January of this year, people wouldn't have had an action step and it would've gotten lost.
KNOX: In her experience, a lot of people are surprised to hear there are health plans they can afford, that many qualify for help in paying the premiums, that they're not going to be penalized on their taxes for not buying something they can't afford.
BICEGO: Once I've talk to them for about an hour about this is actually what the law does, people are just as excited as I am about what this means.
KNOX: And her colleague Brian Rosman predicts that the nation will turn a corner in January when millions of people see what it's like to have coverage.
ROSMAN: Once people start getting benefits and it becomes part of the infrastructure of how our health care system works, the repeal effort will fade away.
KNOX: That's what happened a generation ago with Medicare and Medicaid. They were pretty controversial too. Richard Knox, NPR News, Boston.
NPR transcripts are created on a rush deadline by a contractor for NPR, and accuracy and availability may vary. This text may not be in its final form and may be updated or revised in the future. Please be aware that the authoritative record of NPR's programming is the audio.