President Barack Obama said there's "no excuse" for the technical problems that have plagued the rollout of the Obamacare health insurance website, and promised all Americans would have access to health coverage under his law.
"There's no sugar-coating it. The website has been too slow, people have been getting stuck during the application process," Obama said from the White House's Rose Garden. "Nobody's more frustrated than I am." The president said he is "confident" that the myriad problems with the website, HealthCare.gov, will soon be fixed. The site is the access point to the health insurance exchanges the federal government is operating in more than 30 states.
Nearly three weeks into the rollout of Obama's signature domestic policy achievement, evidence is mounting that the technological difficulties stymieing enrollment into health insurance are deeper than the White House anticipated and could take weeks or longer to address.
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Jonathan Cohn deserves a Pulitzer for his in-depth, all encompassing report on The Affordable Health Care Act. Cohn is an American author and journalist who writes mainly on United States public policy and political issues. Formerly the executive editor of The American Prospect, Cohn is currently a senior editor at The New Republic magazine. Wikipedia Read on.
NEW REPUBLIC JONATHAN COHN
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Administration officials have said they never expected so many initial visitors and that the high demand is a good sign. Both claims are true. But the system quite obviously suffers from serious design flaws. I’ve spoken to about a half-dozen developers in the week and they pointed to some of the same problems that experts in the Wall Street Journal, Washington Post, Kaiser Health News, and Slate identified previously. It's hard to know how much of the second-guessing is accurate. But there's a broad consensus about one early source of trouble. As a story in the Journal explained, the site initially required visitors to create accounts before shopping, because a tool to allow anonymous browsing wasn't ready on time. Establishing an account is among the more complicated tasks the website must perform—it requires sending information back and forth between multiple systems, all through secure channels. The result was a bottleneck.
In fairness, federal officials operated under tremendous political and logistical constraints, the kind few outsiders can grasp. Private developers don't have the same stringent standards for privacy and security, for instance. And given the enormous challenges of trying to integrate so many systems—some new, some old—nobody seriously expected the launch of Obamacare’s federal websites to take place without glitches. But few expected this many problems. And nobody seems quite sure when things will get better.
Here’s, Vicki Tucci, who works with the Legal Aid Society of Palm Beach County, Florida, and who spoke recently to TNR reporter Mimi Dwyer:
There’s long periods where it will just be a wait, then the system will kick you out, or it won’t let you go any farther--that kind of stuff … You can only get to a certain point in the process and then it shuts you out … Most people are frustrated. Last week we had a week full of appointments scheduled and we’ve had to reschedule those appointments. Today I had to reschedule a woman for the second time.
People trying to get insurance have been remarkably patient, which tells you something important about how dysfunctional and frustrating the old insurance market was. In fact, one of the most insightful analyses of Obamacare’s federal site came from John Green, co-producer of Vlogbrothers—who tried applying for insurance via an Obamacare exchange (one the federal government is running for Indiana) and then compared the experience to applying for insurance the old way, via an insurance company website. Even with the delays and server errors, he found, Obamacare was quicker and easier—mostly because, under the old system, he had to reconstruct several years of his medical history down to every exam and test.
But at some point patience will run out—and delays will start to affect who’s signing up for insurance.
So that’s the part of the story you’ve heard. But it’s not the whole story—not by a longshot.
Obamacare’s architects assumed that most states would opt to run their own marketplaces, with federal officials running only a few. The assumption proved wrong: Pretty much any state with a Republican governor or Republican legislative control said no, adding to the administrative burden on HHS. But 14 states plus the District of Columbia are managing their own markets. Mostly it’s places you would expect—progressive outposts like California, Washington, and New York—where Obama and his policies are most popular. But Kentucky, where a Democratic governor and group of dedicated officials have worked diligently to deliver the law’s benefits, is also on the list.The success of states like Kentucky and New York and Connecticut and California are important for their own sake: By my count, they constitute about a fourth of the national population. But they are also important for what they show about how the law can work, once the technology piece is in place.
Kevin Counihan, chief executive of Connecticut’s health marketplace, told me last week that
The system has been working well and consistently since Tuesday afternoon on October 1. We were down from 12:30 until 2 that day, for a fix, but we’ve had no problems since. We are able to process applications through enrollment and we don’t have issues with wait time.As a result, Obamacare in these places seems to be working more or less like it's supposed to work. Consumers are getting opportunities they never had before—to shop for insurance plans, each one with clearly defined benefits that make true comparisons possible, and to receive substantial financial assistance that provides many with thousands of dollars a year in assistance. And, from the looks of things, people are taking advantage of it. The Advisory Board, which is tracking state figures, says that about 180,000 have completed applications for insurance and, of those, 50,000 have enrolled.
Licelot Miguel, a navigator in New York, told Dwyer. (Miguel emphasized that she was speaking for herself, not on behalf of her organization.) The first day was tough, Miguel said: It seems some browsers weren’t working. But now the slowdowns tend to be human rather than technological, Miguel said, because people need 15 or 20 minutes to choose the right plan. “When you get through to the end, it’s like oooooh. People get excited.”
Help navigating the federal online insurance exchange was available in Salt Lake City on Oct. 1.
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The best evidence we have about enrollment patterns comes from a New England Journal of Medicine paper written by economists Amitabh Chandra, Jonathan Gruber, and Robin McKnight. They examined the Massachusetts reforms, during the first year, to see who signed up and when. Most people waited until the last minute—the point at which delay meant incurring financial penalties under the mandate. Relatively speaking, the latecomers were more likely to be young and healthy people, the ones whose support the system needs to function properly. That’s good news, because it suggests the most tentative consumers—the ones least likely to wait out website delays—haven’t started shopping yet.
Massachusetts provides another lesson: Early logistical and technological problems aren’t the end of the world. Stephanie Mencimer recalled the history recently in Mother Jones:
After the law went into effect in Massachusetts, state offices were totally overwhelmed by the number of people clamoring to sign up for insurance, or what the state's Medicaid director dubbed the "stress of success." Lost paperwork, computer glitches, confusion over who was eligible for what, and not enough staff to handle the workload meant that in those early days, consumers could wait several months after submitting an application to finally get coverage. So many people were trying to enroll in the expanded Medicaid program that the Medicaid agency ended up with a months-long backlog of applications.
Medicare Part D, the prescription drug benefit that the Bush Administration introduced in 2006, had its own problems at the start. Now the program works seamlessly. “We saw the same kind of challenges in Part D and they sorted themselves out,” Karen Ignagni, the head of America’s Health Insurance Plans (AHIP), told me recently. She would know. One reason the Bush Administration was able to correct the problems of Part D is that groups with a stake in success, like the insurers, lent a hand. Insurers are doing the same thing now—in no small part because the high web traffic suggests a large market of new and enthusiastic buyers.
Setting up insurance marketplaces was always bound to be more complicated, just because it requires reinventing the existing market. But that effort has also achieved more than most people seem to realize. Insurers are offering competitive premiums, lower even than projections had suggested. And it's for a product—comprehensive insurance, available to anybody at uniform prices—that in most places insurers never offered before.
That leaves just one, final challenge: Making sure people can actually buy the insurance, and apply for the federal subsidies, so they can get the security they've craved for so long. It's no minor thing: Given the depth of problems at the federal sites, there's obviously a lot of work to do. And if it's months, rather than weeks, before the federal sites are working, the administration will need to consider other actions—whether it's quickly developing alternative methods of enrollment, extending the open enrollment period beyond March 31, or even offering short-term extensions and exemptions from the mandate in those states where people can't enroll easily. (Dan Diamond and Jonathan Chait discussed those possibilities recently.) But the administration still has plenty of time to get this right, just as some states have already.