1. So far, the Affordable Care Act's launch has been a failure. Not "troubled." Not "glitchy." A failure. But "so far" only encompasses 14 days. The hard question is whether the launch will still be floundering on day 30, and on day 45.
As Sarah Kliff noted, Medicare Part D was, at this point in its launch, also considered a disaster."When online shopping for prescription drug programs launched back in 2005, things went so badly that the federal government didn't even get off the ground until three weeks after its scheduled launch." Today, Medicare Part D is broadly considered a success.
But Medicare Part D had something the Affordable Care Act doesn't: An opposition party that decided to be constructive. The federal health-care law's not going to get much help from the Republican Party.
2. Are there problems behind the problems? In the weeks leading up to the launch I heard some very ugly things about how the system was performing when transferring data to insurers -- a necessary step if people are actually going to get insurance. I tried hard to pin the rumors down, but I could never quite nail the story, and there was a wall of official denials from the Obama administration. It was just testing, they said. They were fixing the bugs day by day.
According to Bob Laszlewski, those problems aren't resolved. They're just not getting much attention because the health-care law's Web sites aren't working well enough for people to get that far in the process. Laszlewski does a lot of work with the insurance industry, so I'd take this post of his very seriously:
The backroom connection between the insurance companies and the federal government is a disaster. Things are worse behind the curtain than in front of it"
Here is one example from a carrier–and I have received numerous reports from many other carriers with exactly the same problem. One carrier exec told me that yesterday they got 7 transactions for 1 person – 4 enrollments and 3 cancellations.
For some reason the system is enrolling, unenrolling, enrolling again, and so forth the same person. This has been going on for a few days for many of the enrollments being sent to the health plans. It has got on to the point that the health plans worry some of these very few enrollments really don’t exist.
The reconciliation system, that reconciles enrollment between the feds and the health plans, is not working and hasn’t even been tested yet.
If he's right then...yikes.
The health-care law's traffic problems are beginning to subside. Anecdotally, more people are getting through. But most people playing around on the Web site aren't trying to actually purchase insurance. We're far from knowing what the fail rate is for those people trying to take that final step of purchasing a plan.
3. What didn't the White House know and when didn't they know it? In the months before the launch almost every senior member of the Obama administration had a little calendar board tacked up in a prominent spot in their office. "75 days until Obamacare" it would say. The next morning they would tear off the page. "74 days until Obamacare" it would say. The message -- to them and to their visitors -- was clear: This was the White House's top priority.
We're now negative 14 days until the Affordable Care Act and most people still can't purchase insurance. The magnitude of this failure is stunning. Yes, the federal health-care law is a complicated project, government IT rules are a mess, and the scrutiny has been overwhelming. But the Obama administration knew all that going in. They should've been able to build an online portal that works.
Early on, President Obama like to compare the launch of the Affordable Care Act to Apple launching a new product. Can you imagine how many people Steve Jobs would've fired by now if he'd launched a new product like this?
So is anybody going to be held accountable? Is anybody going to be fired? Will anyone new be brought in to run the cleanup effort? Does the Obama administration know what went wrong, and are therr real plans to find out?
What's abundantly clear to anyone who reported on the run-up to the federal health-care law's launch is that the White House had no idea how badly the Web site would perform. They expected problems. But the full extent of the disaster was either obscured or ignored. Heads should roll for that. Changes should be made because of that.
4. One thing has gone abundantly right for the Affordable Care Act: The Republican Party. Their decision to shut down the government on the exact day the health-care law launched was a miracle for the White House. If Republicans had simply passed a clean-CR on Oct. 1 these last few weeks would've been nothing -- nothing at all -- save for coverage of the health-care law's disaster. Instead the law has been knocked off the front page by coverage of the Republican Party's disaster.
In the Washington Examiner, Byron York imagines an alternative history in which Republicans had spent these last few weeks trying to destroy the Affordable Care Act rather than trying to destroy themselves. The scenario he paints is persuasive:
Republicans would have had a true embarrassment of riches when it came to material for the anti-Obamacare campaign. Millions of people tried, and failed, to log into the Obamacare website; lots of stories there. And what about the tales of pathetically small numbers of Americans who actually succeeded in signing up for coverage? For example, there was a report that five people in all of Iowa had signed up; that state's GOP leaders could have been enlisted to make sure everyone knew that.
The various stories would have given Republicans an opportunity to make a much bigger point than simply portraying Obamacare as the work of a gang that couldn't shoot straight. The people who designed the website are the ones who will run the national health care system, Republicans would stress. They'll know everything about your finances and your health. Is that what you want?
Six weeks later, there would've been another opportunity to close the government. And it's entirely possible the federal health-care law still wouldn't be working. At that point, the Republican Party would've had a very good argument for delay -- and certainly a very good argument for delay of the individual mandate. It would be the logical outgrowth of both their messaging and the reality of the law.
But that's not what happened. Instead, Republicans managed to make themselves so unpopular that they've actually made the law more popular. Many Americans believe, reasonably but wrongly, that the reason Obamacare isn't working is that the Republicans shut the government down. And if the Affordable Care Act does begin to improve in the coming weeks Republicans will have lost their chance to harm it.
And it's not as if nobody tried to warn the Republican Party that this was exactly what would happen...
5. This isn't about politics. A lot of liberals will be angry over this post. A lot of conservatives will be happy about it. But it's important to see the Affordable Care Act as something more than a pawn in the political wars: It's a real law that real people are desperately, nervously, urgently trying to access. And so far, the Obama administration has failed them.
The Obama administration's top job isn't beating the Republicans. It's running the government well. On this -- the most important initiative they've launched -- they've run the government badly. They deserve all the criticism they're getting and more.