The Rough Start to the Insurance Exchanges Doesn’t Matter

So what if Obama’s health insurance exchanges didn’t get up and running immediately? That doesn’t mean the program will fail — at least, not yet.

From left: White House Senior Advisor Valerie Jarrett, Chief of Staff Denis McDonough and Health and Human Services Secretary Kathleen Sebelius applaud during President Barack Obama speech about the error-plagued launch of the Affordable Care Act's online enrollment website in the Rose Garden of the White House October 21, 2013.
National Journal
Lucia Graves
Oct. 22, 2013, 7:03 a.m.

The level of hys­teria sur­round­ing the rol­lout of the Obama ad­min­is­tra­tion’s new web­site Health­Care.gov is something to be­hold. “Is Obama­care Pres­id­ent Obama’s Ir­aq war?” a re­port­er tweeted Monday just be­fore Obama gave a Rose Garden ad­dress on the rough start to the Af­ford­able Care Act’s on­line health in­sur­ance ex­changes. An­oth­er com­pared it to Hur­ricane Kat­rina.

Con­ser­vat­ives and the me­dia have been hound­ing the pres­id­ent for his ad­min­is­tra­tion’s shoddy web­site, his staffers’ un­for­tu­nate choice of words and for giv­ing the same press con­fer­ence he would have giv­en if the law’s im­ple­ment­a­tion had been smooth. None of that mat­ters very much.

There are two is­sues fa­cing the ad­min­is­tra­tion right now with re­spect to the ACA. One is­sue is that the ad­min­is­tra­tion’s web­site doesn’t work. The oth­er is wheth­er Amer­ic­ans will have ac­cess to qual­ity, af­ford­able health care cov­er­age come March. That’s what ac­tu­ally mat­ters. And so far there’s no reas­on to think that the an­swer to that lat­ter ques­tion is no. Not yet, any­way.

In a private back­ground brief­ing with a hand­ful of journ­al­ists in the West Wing on Monday, the ad­min­is­tra­tion did not make any prom­ises as to when its web­site would be up and run­ning. “It isn’t the nature of com­puter glitches to say with 100 per­cent cer­tainty this will be fixed by X date,” an of­fi­cial ex­plained. Said an­oth­er, when pressed, “I can’t say to you right now wheth­er it’s a day or a week. What I do know is that we are throw­ing everything at it 24/7.”

A re­port­er asked if it was pos­sible the web­site couldn’t be fixed. “We don’t be­lieve that to be the case,” an of­fi­cial said.

We are cur­rently three weeks in­to Obama­care’s six-month open en­roll­ment peri­od and still the web­site has not been fixed. That’s a far cry from a death sen­tence. Of­fi­cials said Monday that they ex­pec­ted en­roll­ment in Oc­to­ber to be low, with a spike in Decem­ber pri­or to be­ne­fits be­gin­ning in Janu­ary, and an­oth­er spike in March be­fore the in­di­vidu­al man­date kicks in. Young people, in par­tic­u­lar, are ex­pec­ted to sign up closer to dead­line, ac­cord­ing to the ad­min­is­tra­tion’s mod­els.

Those mod­els aren’t base­less. When Mas­sachu­setts rolled out a sim­il­ar health in­sur­ance man­date in 2007, the biggest spike in en­roll­ment came in the two months lead­ing up to the time that people would be charged a pen­alty for not hav­ing cov­er­age, ac­cord­ing to Jon Kings­dale, who ran the state’s health-be­ne­fit ex­change at the time.

“The ana­logy is im­per­fect but the the lo­gic is cor­rect,” said Kings­dale, now a health ex­changes and health care re­form ex­pert with Bo­ston’s Wakely Con­sult­ing Group. In Mas­sachu­setts, nobody was sign­ing up in Oc­to­ber for in­sur­ance they would re­ceive in Janu­ary, and Kings­dale said he’d al­ways as­sumed en­roll­ment for Obama­care would be re­l­at­ively low too. “Not a lot of people want to pay in Oc­to­ber for be­ne­fits that don’t start un­til Janu­ary,” he ex­plained.

That’s not to say the Obama ad­min­is­tra­tion has the prob­lem un­der con­trol. De­tails about what’s gone wrong with the site have been ex­tremely vague. We still don’t have a clear ex­plan­a­tion of what went wrong and there’s reas­on to think the prob­lem can’t be fixed par­tic­u­larly quickly. In the in­ter­im, of­fi­cials are em­phas­iz­ing the non-di­git­al entry points to their sys­tem, in­clud­ing the abil­ity to call in or send a pa­per ap­plic­a­tion. That’s not, however, a sub­sti­tute for mak­ing their web­site work.

The ad­min­is­tra­tion still has time to do that. Al­though only 14 per­cent of adults say they have already vis­ited one of the ex­change web­sites, an ad­di­tion­al 23 per­cent say they think they will do so in the next few months, ac­cord­ing to a sur­vey by the Pew Re­search Cen­ter con­duc­ted Oct. 9 - 13. Those without health in­sur­ance are more likely than those with in­sur­ance to have already vis­ited (22 per­cent vs. 12 per­cent) or to plan to do so (42 per­cent vs. 19 per­cent) in the com­ing months.

The ques­tion is, at what point will a dys­func­tion­al web­site im­pede the law’s abil­ity to func­tion? White House of­fi­cials didn’t have a tar­get date for that but most ex­perts point to some time around mid-Novem­ber, or even Thanks­giv­ing, as the cru­cial mo­ment when the health in­sur­ance mar­ket­place needs to be work­ing.

“There are two cam­paigns,” Kings­dale told me, “the en­roll­ment cam­paign and the polit­ic­al cam­paign. Oc­to­ber is ob­vi­ously very big in the polit­ic­al cam­paign but it’s not that big in the en­roll­ment cam­paign. Novem­ber is the month that’s key.”

On Monday I pressed ad­min­is­tra­tion of­fi­cials for a con­crete “drop-dead” date and they couldn’t give me a time frame. In­stead they poin­ted out the good that the law has done already, such as the fact that in the course of 17 days, 56,000 in Ore­gon have signed up for the health law’s Medi­caid ex­pan­sion. “That num­ber is go­ing to dra­mat­ic­ally in­crease over the course of the next six months,” they ad­ded. It hasn’t been a Whole Foods shop­ping ex­per­i­ence; that much we know is true. The ques­tion now is what hap­pens in a month.

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