Last week 13 attorneys general sent a letterto Health and Human Services Secretary Kathleen Sebelius expressing privacy concerns over the Affordable Care Act. 

Their specific concern is the enrollment procedures for the health insurance exchanges (HIX) being planned under the law. The AGs told the Secretary that the people who take your personal health information when you enroll in an HIX aren’t adequately trained in how to handle it.

I should add that the 13 AGs represent states that have declined to establish their own state exchanges.

Last month DHHS released a final rule requiring so-called navigatorsto have at least 30 hours of training in handling your private information. But the problem, say the AGs, is that DHHS isn’t requiring background or criminal checks on the people who handle your most private information. 

In fact, the standards for people who sell you health insurance are tougher than the security standards for these navigators, according to the complaint. The AGs point out that on a state level these health insurance sellers and brokers, unlike the "navigators" who handle the same private information, are subject to strict exam-based licensing. 

The DHHS response? The navigators have been trained enough and that’s that.

Call me crazy, but this strikes me as a cavalier response to the AGs.  I think the screws on our personal privacy are getting a little loose. Where I live, even Little League® coaches have to undergo criminal background checks. Teachers have to undergo three security clearances—a sex offender registry check, a state police background check and an FBI fingerprint check. All to pass out the white paste and crayons.

Why shouldn’t I know that that the person who is looking at my most intimate personal information—my health—isn’t a criminal who is going to sell my information? It’s pretty simple. I know that sometimes this privacy thing gets out of hand. It’s a relative thing. I don’t really care who knows what movie I took in last Friday night at the multiplex. But I might care a lot about who knows my diagnosis following a college weekend in Tijuana 20 years ago.

I think most people would agree that we need to update how we delivery and pay for healthcare. But the polls have consistently shown consumer opposition to the Affordable Care Act. Blowing off legal concerns about security is a bad way to convince already skeptical consumers that the ACA is will be a change for the better.

This week we commemorate the 150^th anniversary of the Battle of Gettysburg. That turning point of the American Civil War pitted friend against friend, brother against brother, state against state. Perhaps it’s fitting at this time that we revisit another more recent battle that pitted American against American—the battle over the future of healthcare.

Wherever you came down on the Affordable Care Act of 2010, either in favor of the law or against it, is irrelevant now. It’s a round that’s been fired. You can’t get it back in the casing. Now is the time for the law’s supporters and opponents to deal with the implementation, which will be messy. Just this week the government announced a one-year reprieve for large businesses to comply with the law’s mandatory insurance requirements.

So, there are five things consumers need to know about health care going forward.

First, in six months the policies sold by “insurance exchanges,” the crown jewel of the law, begin taking effect. That means if you’re not covered by insurance through an employer, the Medicaid program or Medicare, you’ll need to buy health insurance or pay a penalty. The exchange in your state is a likely place to start looking.

Second, in this new world of health insurance, no good deed goes unpunished. So if you’re a healthy adult who’s taken care of himself all these years, you’ll probably pay more than you have been paying for insurance. A lot more.

The third thing you need to know about health insurance is that the law now mandates guaranteed issue of policies. This means, like the announcer on late-night cable TV says, you can’t be turned down. Regardless of your health condition you’ll be issued a policy.

If you’ve got a pre-existing condition, in all probability that policy will cost less than what you have been paying on the open market. But how can the insurance carriers do that? How do they offset the risk that you present to them? Simple. 

And that’s the fourth thing you need to know about the new world of health insurance under the ACA. The premiums of healthy insureds will be going up to subsidize the risk presented by the less healthy policy-holders.  In essence, if you’re a healthy non-smoker in your 20s or 30s you’ll be paying to cover the risk presented by other, less healthy, policy holders.

So who wins and who loses under this new system? Clearly, the winners are those individuals who have trouble getting affordable insurance now or who have altogether been priced out of the market because of their health conditions. The losers are those healthy, demographically benign individuals who will see their rates go up.

For example, in one analysis, a 40-year-old nonsmoker in Virginia today could obtain a high-deductible ($5,000) plan, which would cover half his medical costs for about $60 per month. By comparison, the least expensive plan available through the exchange system will cost him nearly $200 per month.

Unknown at this point is how many healthy individuals will resist seeing their premiums more than triple going forward. In order for the exchanges to function they’ll need as many nonsmoking vegans, joggers and yoga enthusiasts as they can get. If they bail out of the insurance market and just decide to pay the penalty for not carrying insurance, the actuarial tables get really sideways really fast.

So the fifth thing you need to know about the new healthcare law is your options. If you’re that healthy, middle-aged individual, you need to develop a plan now to anticipate the changes coming next year. Compare insurance quotes—to each other and to what you’re paying now. Examine what your liability would be if you “ran bare”—without coverage. Know now what changes might be in store for your current policy.

Guaranteed issue is an attractive concept and papers over a lot of the flaws in our current healthcare system. But the cold, hard reality is that someone has to pay for it. And like everything else that seems too good to be true, that person is you, the consumer. 

When it comes to health insurance many consumers apparently have the same cavalier attitude that they have about their own medical care.

A recent survey for online broker InsuranceQuotes.compolled over 1, 000 adult consumers about their knowledge of insurance and the Affordable Care Act. Among the findings:

Worse than that, nearly two-thirds of respondents say the new law will result in more, not less, expensive healthcare. Fewer than half said the law would result in an improvement in the health of Americans.

The law’s proponents say that the survey results prove that consumers are misinformed about the new health law.  I disagree. Especially when a search of the term “Affordable Care Act” leads you directly to a variety of the government’s own sites, including the White House.

The only thing easier than finding information on the ACA is blaming the law’s opponents for survey results like these. Ten percent uninformed about the law I could see. Twenty percent. But when you’re looking at two thirds of the people the law was intended to help unsure and apparently unconcerned about whether they’ll take advantage of the ACA’s benefits, I don’t think you can pin it on cable TV or insurance companies.

I think if the survey proves anything it proves that no matter how much government might like to help people, some people don’t want the help. Think about it: How much have we as a nation, through our taxes, insurance rates and cost of goods purchased, paid for wellness programs? Smoking cessation advertising and classes? Gym memberships? The results? Conditions like obesity, diabetes and heart disease are at still at epidemic levels. And still you have consumers, including children, sitting on their butts for hours at a time, watching TV, chowing down a bag of Fritos and washing them down with a liter of their favorite sugary drink.

Let’s face it. Consumers themselves shoulder a lot of the blame for the nation’s health crisis. Congress and the president engineer a law to re-shape what by year 2021 will be 20% of the economy, and you ask those people the law was intended to help if they’re going to take advantage of it and the answer is a shake of the double chins and a puzzled “I dunno.”

Call it misinformed or uninformed; it’s the same thing. You live in this country for four years of screaming 105 decibel debates over the ACA and you still don’t know whether you’re going to buy insurance, or if you’re even eligible for it? That’s the real problem with the ACA. Being uninformed and unsure about the law goes hand in hand with bad lifestyle choices, overeating, not taking your meds, or not getting checkups.

The fact is that too many consumers are divorced from their own health care.

They’re divorced from the responsibility of keeping themselves healthy and figuring a way to pay for it so the rest of us don’t have to.

That’s the real problem with the ACA. And until you solve that, until you make people responsible for their own well-being, you’re going to continue to have this rancorous and now pointless debate. 

In the seemingly endless war over the Affordable Care Act, President Obama was able to claim a significant victory last Friday during what amounted to a campaign stop in California. The President chose the occasion to tout California as a model of the new healthcare law’s effectiveness.

The President has chosen to portray the continuing unpopularity of the ACA as the result of misunderstanding and misinformationon the part of the law’s detractors. And he may be right. Even for healthcare professionals this is a tough bill to figure out. So, when California’s healthcare exchange announced that the individual coverage plans to be offered next year by the exchange would be cheaper by up to 30% than comparable private sector plans today, it was time to celebrate.

But not so fast. The Lobster Shift wouldn’t be the Lobster Shift if it didn’t take a contrarian look at things (See our January 10, 2013 post). And if there is anything in this world that requires a skeptical look, it’s healthcare insurance.

Upon further review, it now looks like the optimistic projections of insurance offered at 2% to 29% below current markets was a case of California Dreamin’. Here’s why:

The California exchange regulators were comparing apples to oranges. They chose to compare the projected exchange rates to California’s current small-business market, where the heavy hand of state regulators has already distorted the market to the point where the exchange rates look good by comparison.

A more accurate comparisonwould have been comparing the exchange’s individual insurance plans with today’s individual plan market, which in California is more lightly regulated than the small-business market, and as a result functions fairly well.

If you compare apples to apples, or in this case, the current individual market to the individual plans to be offered next year through the state’s ACA exchange, there’s little to celebrate. According to the Wall Street Journal, there are five plans today that are 64% to 117% cheaper than what the state expects to market in the public exchange. That’s hardly worth gassing up Air Force One to fly across the country.

The narrative is now shifting. OK, say the regulators, we goofed. The individual market will be more expensive, but beneficiaries will be getting a lot more benefits. However, the cost-benefit of paying for birth control, fertility coverage and to have his children covered till they’re 26 may escape that 25-year old male whose focus may be restricted to hot cars and weekends at the beach.

The President is probably right about the misunderstanding and misinformation when it comes to the ACA. All the more reason when one side or the other claims victory in the healthcare battle to take a second look at the claim.