Welcome to Health Reform Watch, Sarah Kliff’s regular look at how the Affordable Care Act is changing the American health-care system — and being changed by it. You can reach Sarah with questions, comments and suggestions here. Check back every Monday, Wednesday and Friday afternoon for the latest edition, and read previous columns here.
Days until marketplaces launch: 11.
The health law's online marketplace launch is in 11 days and, as the Wall Street Journal reports this morning, there will be glitches. Reporters there write that, right now, government software "can't reliably determine how much people need to pay for coverage."
Yikes! This means it's time to play a favorite Obamacare game called Is It Time To Freak Out Yet? Previous rounds include but are not limited to the delay of the employer mandate, out-of-pocket spending limits, income verification processes and the small business health exchanges.
There are two questions, it seems, that are crucial here. First: How well are the marketplaces working? Second: How much will that matter for Obamacare?
Tackling the first question first: There's no doubt right now that the marketplaces are experiencing glitches and are still a work in progress, much more so than designers expected when they began building the Web sites.
"They're still making changes on the fly as they identify bugs," said Kevin Walsh, managing director for health eligibility systems at Xerox, which is consulting with about a half-dozen states on their exchanges. "You test it and find out how far you can get, and hopefully get a little further the next time. It feels uncomfortable to be doing end to end testing as you get so close to going live."
There are still 11 days left until the marketplaces launch, which is not a whole lot of time. Keep in mind that the marketplaces are incredibly complex technological systems, ones that have to take in data from numerous state and federal sources and crunch them all together to figure out who qualifies for what health-care programs.
That complexity has proven to be a challenge for building the data hub. So Walsh expects that in some places, it might be possible to download an application and explore rates, but difficult to complete the purchase of a health-care plan.
"If this wasn't such a date-driven project, I think a lot of people would be having discussions about slipping the date," Walsh says. "Instead, you slip out some of the functionality because the go live is so important."
Oct. 1 is increasingly being seen by states and outside analysts as a "soft launch," where they will work out the types of kinks in the system that the Wall Street Journal reported on this morning. Because coverage of the new plans doesn't start until Jan. 1, officials believe they have a three-month period to fix bugs and sort out problems without having a significant impact on Americans' access to coverage.
"Nobody is going to say we're not starting on October 1," says Joel Ario, who previously oversaw health exchanges at HHS, "but in some situations, you may see a redefinition of what 'start' means."
This leads to the second question: How much will this all matter for Obamacare? There will be no shortage of political backlash when someone tries to buy insurance on Oct. 1 and, inevitably, hits a glitch. What does that mean for the health-care law's long-term success?
Leaving politics aside, there's not much in the way of policy ramifications in store if it's difficult to buy health insurance Oct. 1. The health-care law doesn't allow these new insurance policies to start until January, so there is literally no difference between buying coverage Oct. 1 or mid-December.
Still, a bad experience in early October doesn't come without consequences: You could see someone who has a bad experience attempting to buy coverage the first time, who decides to forgo the process rather than return in December or January.
When we've launched health insurance expansion in the past, the rollout has been far from perfect. On the eve of Medicare's launch, back in 1966, the federal government was wondering whether some Southern hospitals would even participate in the program that required them to desegregate their patients. Medicare Part D was less popular than Obamacare when it launched. Seniors turned up at drugstores thinking they had coverage when they didn't; only two-thirds of their phone calls to a government phone number were answered accurately and completely.
A survey of Medicare Part D beneficiaries last week found that 92 percent describe themselves as satisfied with the health plan.
We don't have a crystal ball to gaze in that could tell us whether the past is prologue when it comes to building really big government health programs. What we do know, though, is that there are challenges right now, similar to ones that have existed in the past. There's worry about what exactly will launch Oct. 1, and how well it will work. And there's a sense that there is still a bit of time — but not a lot — to sort out those issues before they become a major problem.
KLIFF NOTES: Top health policy reads from around the Web.
The House has passed a plan to defund Obamacare. "The House passed a short-term spending plan Friday morning that would continue funding government operations through mid-December but withhold funding for President Obama’s signature health-care law, firing the opening salvo in what promises to be a contentious 10 days of debate on Capitol Hill over extending government operations by only three months." Ed O'Keefe in The Washington Post.
The White House and Texas are fighting over health law outreach. "The Obama administration is accusing Gov. Rick Perry of making a 'blatant attempt to add cumbersome requirements' for people hired to help uninsured Texans enroll in health coverage, just two weeks before health care reform insurance marketplaces open." Lora Hines and Patricia Kilday Hart in the Houston Chronicle.
Obamacare's contraceptives mandate may soon hit the Supreme Court. "The Obama administration set the stage Thursday for another Supreme Court showdown on the president's healthcare law, this time to decide whether for-profit companies can be forced to provide full contraceptive coverage for their employees despite religious objections from their owners. The administration's lawyers asked the justices to take up the issue this fall to decide whether these corporations can claim a religious exemption to this part of the healthcare law." David Savage in the Los Angeles Times.