When I was a boy my grandmother lived in a house next to ours.  It was great for running over to see her and for getting a snack.  Grandmother received a Social Security check, and it was a highlight of each month when the check arrived. The friendly postal carrier brought the check right to her door, probably chatting with her for a minute or two.  Oh sure, she had gone to a federal office and signed some forms when she became eligible; but, and this is an assumption, it was pretty simple for her to enroll in Social Security.  If she had questions about the sign-up, she asked the person across the counter. I am pretty sure my dad went with her to help her enroll.

Times change (and who wants to go back to the past), but contrast this story about my grandmother with the process of purchasing insurance through the Affordable Care Act. It is done on the Web through insurance marketplaces or exchanges. This is the first time the U.S. Federal Government has attempted to roll out a huge program via the Web. Problems were to be expected and have indeed materialized. I sincerely hope the problems are corrected soon. I would like to see people able to obtain insurance coverage—that is a good thing when one is in the business of delivering health care.

In this season of Thanksgiving we are blessed at TTUHSC, where we have insurance provided through our employer. Therefore, it is unlikely that as individuals one would ever need to shop for coverage through the insurance marketplace.  Of course, we might try to assist a loved one, or even a patient, navigate an exchange. Remember, the insurance marketplaces are basically designed for people who are uninsured or need to buy individual policies.

Finally, the reason the insurance marketplace is of such importance is that many people will qualify for subsidies to make coverage more affordable—and the exchange is where this information is obtained. Subsidies, in the form of tax credits, help individuals pay their premiums. These tax credits are available to people with incomes up to 400 percent of the federal poverty level. That is about $46,000 for one person or $94,000 for a family of four. And, there are also cost-sharing subsidies to reduce deductibles and copayments, depending on income.

So, from the chatty postal carrier to the World Wide Web—things change, and I would say generally for the better.