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The first scenario is the hiccup scenario where implementation issues are expected in the ACA implementation. This is where glitches are found that some people who qualify for subsidies will not get them and some of those who do not qualify will get them. In addition to this, in the hiccup scenario though a number of exchanges will be set up and companies on the exchanges will not be grow to be as big as expected. Therefore in the hiccups scenario, premiums will go high though only slightly and enhanced services will make people not to mind much about the increase in premium prices Kamarck, 2013()
The second scenario is the delay scenario which the author deems to be halfway between good and bad. This is where the program is less successful in meeting its outcomes and where states have to pull back from some of the key provisions of the ACA. Therefore there are delays in opening up exchanges which will delay enforcement of mandate for everyone to purchase insurance. As a result of this delay, there will be a lengthy bureaucratic process in trying to establish a statewide data interface. Premiums are also expected to rise which will lead to a public outcry but will not affect purchase of insurance by citizens.
The third scenario is the total repeal scenario which according to the author is fatal. Though...
However, only one midpoint is mentioned which is the delay scenario. This is confusing because it leaves the reader wondering about the other midpoints that could exist in this continuum.
The second confusing aspect of the article is on the design of the ACA. The ACA is designed to involved fifty states, fifty state insurance regulators and the entire health care industry. This is a complex design and possibly the reason why it received very little support from democrats and no support from Republicans. This is confusing because it leaves the reader wondering if the ACA had that little support from the legislators, how will it receive support from the public?
Question to author or legislator
The one question that comes to mind regarding this question is on the midpoints that exist in the continuum of implementation. This is a question to the author concerning what other potential midpoints are envisioned in the implementation of the ACA since the only midpoint that is described is the delay scenario.
References
Kamarck, E. (2013). The Affordable Care Act: From Hiccups to Repeal Retrieved June 8th, 2013, from http://www.brookings.edu/blogs/up-front/posts/2013/05/15-repeal-affordable-care-act-kamarck
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