As the debut of Obamacare nears in less than 10 months, officials responsible for implementing the complicated law are starting to warn that it will be a mess.
"We know it's going to be messy," said Jeffrey Crowley, a former top Obama aide on the team that spearheaded development of the Affordable Care Act. "There are going to be things that come up that are unanticipated," he added.
Discussing Obamacare Monday at a Center for American Progress seminar on the law's impact on HIV/AIDS and the lesbian, gay, bisexual and transgender community, the president's former director of the White House Office of National AIDS Policy and senior advisor on disability policy added, "if we do everything we can possibly think of, it's still going to be a messy transition, but we'll end up in a better place."
Added Kali Lindsey, director of legislative and public affairs at the National Minority AIDS Council, "one of the realities of the Affordable Care Act is that everything is not going to be perfect when it's implemented on day one."
One element of confusion will be providing healthcare to immigrants. Undocumented workers were not covered by Obamacare, but federal officials are rushing to win approval of immigration reform that will expand coverage to illegals.
At the seminar, Mayra Alvarez, the public health policy director at the department of Health and Human Services, urged health care advocates to carefully watch the development of immigration reform to make sure coverage is offered.
"Let's keep our eyes on the prize of comprehensive immigration reform," she said. "I just want to emphasize that the undocumented are part of our communities. They are part of the people that many of our organizations serve. They go to school with our children, they work with us. And I think first and foremost the administration is committed to passing comprehensive immigration reform..."
The CAP panel expressed confidence that Obamacare will open the door to wider health care availability for the LGBT community and, over time, the elimination of the "stigma discrimination" many feel at the doctor's office.
There are about 1 million Americans suffering with HIV/AIDS, and the infection rate is growing among black men and gays and bisexuals. But two-thirds are not in treatment programs, according to Jen Kates of the Kaiser Foundation.