OBAMACARE OCTOBER 22, 2013
President Obama’s Rose Garden speech Monday was supposed to send two messages—one, that he is determined to fix Obamacare’s troubled federal websites and, two, that the law is already helping many people get insurance. I happen to believe both claims, but I doubt the event convinced anybody with doubts.
The president had appeared alongside average people who would benefit from the law. But, as the official biographies had made clear, most had not yet gotten insurance. The president had also reminded people that they could use other methods of enrollment, including paper applications and a call center. But reporters who tried calling had trouble getting through. Offstage, administration officials were dealing with a barrage of tough questions: Why had the Department of Health and Human Services released figures for applications but not enrollments? When would Health and Human Services Secretary Kathleen Sebelius give Congress a formal report? Were officials prepared to delay the individual mandate?
The press coverage was brutal, right up to and including the Daily Show. One sketch had John Oliver trapped inside the healthcare.gov mainframe, trying to dodge Pac-Man. “How old is this software?” Oliver asked desperately, ducking as the pixellated yellow chomper worked its way across the screen.
Yes, it was that kind of day for the Obama Administration. And they probably deserved it. The websites that HHS is running on behalf of 36 states didn’t work on October 1, despite assurances that they would, and they didn't work for many days afterwards. Only a fraction of the people who visited were able to make it all the way through the process, from creating an account to applying for financial assistance to choosing a plan. As the president himself said, that's unacceptable.
Officials at the highest levels had expected glitches, not this level of dysfunction. But, as new stories at Bloomberg and the Washington Post confirm, and as reporters at places like the Wall Street Journal were picking up even before the launch, people working directly on the systems knew they were severely troubled and untested. The challenge of building this system was daunting—more daunting than most people, even in the information technology community, seem to realize. But the management failures here were real and took place on multiple levels.
Now that the government shutdown is over, and the media is no longer distracted, those failures are getting the scrutiny they should. But the more important question is about the future, not the past. How long before the federal sites are functioning? And will the administration have to adjust the program—by stretching the open enrollment period, for example, or tinkering with the mandate—to give people more time to sign up?
Nobody knows the answers to those questions right now. Last week, Yuval Levin of National Review offered a sober—and sobering—assessment of how things look from inside HHS. Levin has been among Obamacare’s most relentless critics, but he also worked in the Bush Administration and he knows his stuff. Based on conversations with people in and out of government, he described a sense of “restrained panic.” As he and others have noted, the visible problems on the front end of the system—the difficulty people have had merely creating other accounts—are likely masking other problems deeper within the system. Among them: The system is giving insurers garbled or incorrect information about people who have enrolled.
His impressions are consistent with what I, like plenty of other reporters, heard in those first two weeks. But Levin also noted that he had been through a similarly trying experience in the aftermath of Hurricane Katrina. (As he made clear, he meant similar in the way bureaucracy reacted, not the situation itself.) At this point in a crisis, he pointed out, there’s a tendency to fear and assume the worst—even when that might not be the case.
And there are genuine reasons for optimism, if you’re looking for them. The administration isn’t lying when it says the federal sites are functioning better than they were. More people are finally getting through those opening stages of the process. The underlying architecture is also getting much-needed attention, although it’s not the kind of stuff people will notice right away. For example, a source familiar with the situation tells me that the system now has much better “instrumentation”—in effect, spots in the code that allow HHS to figure out how well different parts of the process are working. That will make it much easier to pinpoint problems and check fixes as they take effect. Meanwhile, the states running their own sites are doing a much better job—the reports (and first-hand accounts I’ve heard) from California, Connecticut, Kentucky, New York, and Washington state are proof that the online system can work and, for the many people living in those states, are working already. That's a whole lot of people for whom Obamacare is doing what it's supposed to do.
Nobody is making quotable predictions about when the federal sites will catch up. Even if they did, who would take such assurances on faith? The key issue, again, is whether repair work takes weeks or months. If it’s weeks, then the program should be able to function without adjustment. This episode will become a case study in management classes across the country—and, hopefully, an impetus to reexamine federal procurement and contracting policies. (Read Lydia DePillis on this if you haven't already.) But it will become a mere footnote in the history of health care reform. If the federal websites aren’t in much better shape by late November or early December, then the problems will threaten to disrupt the scheme for next year, forcing the administration to consider changes to open enrollment, the mandate, and so on. You'll start hearing a lot about "break-the-glass" plans.
But, assuming the administration is doing everything it can, there's really nothing to do between now and then except wait. And, here, Obama appears to have one very key ally: The public. Polls show the voters want to give the law a chance to work. Here’s Greg Sargent’s summary of the latest ABC/Washington Post poll:
The poll finds that 46 percent support the law, versus 54 percent who oppose it or are unsure of their feelings about it. But that second bloc breaks down into 33 percent who oppose and want repeal, versus 20 percent who oppose the law and want to let the law go ahead. That means a total of 66 percent either support the law or oppose it but want it to go forward.
This is the case, even though a majority believes the law has problems that run deeper than the ones we’re seeing with the web site. And that finding is similar among independents, too.
I asked the Post polling team for a further breakdown. Of those Americans who think the law’s problems run deeper than the Web site, even they are almost evenly divided on whether to give the law a chance. Of that group, 51 percent want it repealed, while 47 either support it or oppose it but want to let it continue.
Another poll suggests Americans who have used the new websites find them considerably less awful than all of the reporters writing about them. Via the Huffington Post:
Americans' first impression of the new online health insurance exchanges is "a bumpy launch," according to a Pew Research poll released Monday, the same day President Obama acknowledged the widespread technical problems with the rollout of HealthCare.gov since Oct. 1.
Yet, while many were aware of the website's problems, the 1 in 7 Americans who have visited the site largely found it usable, according to the survey, conducted earlier this month.
I was going to say this is both miraculous and surprising. But it actually makes sense, given the reality of our health care problems and how Obamacare seeks to fix them.
People mocked Monday's Rose Garden appearance, because Obama sounded like a salesman hocking steak knives on QVC. But the store analogy, which Obama himself uses, is a good one. People desperately need a product—in this case, affordable health insurance—and, thanks to Obamacare, the product is finally available. But most people can’t get in the store to buy it and those that do make it inside can’t check out. It’s frustrating but, then, so is not having access to insurance at all. If you’re among the uninsured or under-insured, you’ve been waiting a long time for decent coverage. You can wait a little longer.
Public patience may not last forever. And for people who have insurance already, access to the exchanges is a more pressing issue. They’re just now learning about next year’s rates, which are generally higher because of the law’s new requirements. Obamacare’s tax credits should offset the increase partly or entirely for most of them. (Many, quite possibly a majority, will actually end up spending less.) But the only way to get the tax credits is to go on the websites. That’s one reason the next few weeks are so important—and why, inevitably, the administration will have to put up with more days like Monday.