Obamacare’s launch was bad. But many programs for the poor are worse.

January 7

David Super is a professor of law at Georgetown University. On Friday, he wrote a New York Times op-ed arguing that, as bad as Obamacare's launch has been, "food stamp and Medicaid recipients can only look on in envy." In it, he offered examples of the terrible service the government often offers to the poor, including a Colorado program that "refused food stamps to anyone who did not have a driver’s license from Guam" and a Georgia disaster that failed "to send renewal notices to the homes of some 66,000 food stamp recipients and about half that number of Medicaid beneficiaries: and terminated their coverage on November 1st."

We spoke by phone on Monday. A lightly edited transcript follows.


This isn't as bad as it gets. (KAREN BLEIER/AFP/Getty Images )

Ezra Klein: How does the launch and subsequent trajectory of HealthCare.gov compare to what you typically see in programs for the poor?

David Super: The early months were very typical of what we see whenever a new system is implemented that affects low-income people. But the recovery has been startlingly fast.

EK: So what happens in these programs typically? They launch, fail, and then what?

DS: They just thunder on ahead. The system that’s broken down spectacularly for food stamps and Medicaid in Georgia began as a pilot in a few counties a year-and-a-half ago. It was a miserable failure there. Federal administrators tried calling the toll-free number to get help themselves and couldn’t get through. But they rolled it out anyway.

EK: What’s the decision chain that ends up justifying scaling up a failing pilot?

DS: There’s this idea, “we’ve gone this far, we should keep on going.” You hear people say that this has to be done sooner or later and we might as well do it now. Or they say, “we should take our lumps.” It always makes my blood boil because it’s not the administrators taking the lumps.

EK: There’s an old line that goes, “programs for the poor are poor programs.” When you compare programs that are used by the poor, like food stamps, to programs used by Americans of all income brackets, like the IRS or the DMV, do you think the old adage holds true?

DS: It’s night and day. I hear people complain about the IRS and I’m just astounded. Its level of customer service is radically better than what we see in even fairly well-run poverty programs. There’s all sorts of things the IRS would never dream of doing that are absolutely routine in these other programs. They actually give people a chance to explain things.

EK: These programs are designed with good intentions. The people behind them care. So how do you end up in a situation like Georgia, where many of the people can’t even get through the phone tree? What goes wrong?

DS: There are many reasons. But the reason there are a lot of problems right now is we’ve had so many consecutive years of state budget cuts and hiring freezes. Many states pay very, very low wages for people administering these programs, and so there’s a lot of turnover. So when the state has a hiring freeze, the better-paid agencies don’t shrink very much, but these programs shrink enormously. So they just don’t have enough bodies.

EK: I think someone reading this interview could say, “this is just more evidence that government can’t manage these things well and should stop trying. Give the money to the private sector and let them invest it, or give the programs to private contractors and let them manage them.” Do you agree?

DS: I don’t think that matches up with the evidence. There are a number of states running very good food stamp programs. They’ve chosen to devote the resources necessary to making things happen. When they try something new, they try it slowly enough to make corrections when there are problems. And in terms of outsourcing to the private sector, that’s where a lot of these problems come from. Georgia shrank so much that it outsourced to private contractors, and those private contractors didn’t send out the right letters and 66,000 people got thrown off the benefit through no fault of their own.

EK: So how do these programs get improved? With Obamacare, a lot of middle class, and even upper middle class, people were using the system, and because it was all online, it was easy for journalists to try it out, and so there was a lot of public pressure. But what do you do when services don't get as much attention and don't have beneficiaries with political power?

DS: Having people with political clout involved certainly makes a big difference. In 1995 or 1996, when the means-tested programs were being overhauled in Congress, the cuts to the school lunch program were far from the most severe being imposed. But because they hit middle-income kids, the outcry was enormous and they were dropped even as more severe cuts to things like food stamps went through.

But to the extent we can’t get to that, we need to see federal agencies adopting and enforcing best practices, in particular standards for proper testing before rollout, proper success in pilot programs before things go statewide, and proper human fallback to make sure that people aren’t cut off from the program if the automated systems fail.

Correction: The original version of this article misidentified "David Super" as "Peter Super." The article has been fixed, and the author has been forced to go stand outside in the cold as punishment.

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