The transition period needed to implement sweeping health-care reform is sure to test the patience of Americans who already are antsy about the struggling economy and skeptical of government and private institutions.



Many of the major provisions of the reform legislation signed into law by President Obama earlier this year, such as health exchanges, will not take effect until 2014. Meanwhile, a slow economic recovery is predicted by many analysts following the worst downturn in 70 years and the loss of millions of jobs.

The bad economy, combined with the nonstop criticism of health reform by politicians who voted against it, make it hard to be optimistic about health care. And yet, a positive approach is exactly what is needed now. Elected officials, health-care advocates and health professionals need to work together on ways to bridge the gap for Americans who are uninsured, underinsured or may lose coverage in the next few years because of job loss or some other life event. Some stopgap programs could make all the difference.

Immediate problems include:

• The end of a federal subsidy for 65 percent of the cost of COBRA medical coverage for workers who have lost their jobs. The subsidy ended in June, and the percentage of out-of-work adults applying for COBRA continues at twice the rate it did before the subsidy began in 2008. The higher enrollment, in turn, is keeping costs higher. While the politically popular stance right now is to freeze all spending, Congress should look to reinstate this subsidy in the short term, until the job market improves and key provisions of health reform kick in.

• The cost of employer-subsidized health insurance is likely to go up next year, according to surveys. A study by Aon Consulting says 65 percent of employers will ask employees to shoulder more of the cost of deductibles, co-payments and out-of-pocket maximums in 2011.Many employers doubtless feel they must increase cost sharing or else put even more people out of work. The best course here may be to hold the line with insurance companies. Some $46 million in new federal grants is going to states to give them regulatory powers to prevent insurers from instituting major rate increases.



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