December 21, 2013

ON FRIDAY, President Obama sought to reassure Americans that the Affordable Care Act, his biggest legislative accomplishment, is on track. He said that more than 1 million people enrolled in private health insurance plans through the law’s online marketplaces since Oct. 1, with the pace accelerating in December. Higher enrollment is good news. But just a few days from the law’s first major coverage deadline, the administration is still failing to inspire confidence that the policy is on firm footing.

Enrollment is far from the 7 million the Congressional Budget Office estimated would be signed up by next March, the final deadline to get 2014 coverage. Missing that target would not be a disaster — as long as a diverse group of people signs up. The system needs to attract healthy participants to offset the costs of the sick, and it’s not clear how well it’s doing that, nor will it be for a long time. A lack of balance would challenge the system’s cost structure — and, possibly, its long-term viability.

A policy shift announced Thursday infuriated insurance companies because they worry the administration has offered healthy people another way to avoid the insurance pool. Calling it a clarification, Health and Human Services Secretary Kathleen Sebelius announced that people whose current insurance plans were canceled because their policies didn’t comply with the new law would be eligible for a temporary exemption from the requirement that they purchase qualifying health insurance next year. If those people can credibly claim that they don’t have affordable options on the new marketplace, they will be able to buy skimpy “catastrophic” plans for next year. That would pull them out of the insurance pool.

The number of people who will take advantage of this new coverage avenue is probably small. Many people with canceled plans will get good deals in the marketplace. Others have arranged insurance for next year. Insurance companies might not be ready to accommodate many of those seeking catastrophic plans, anyway.

But all of these last-minute policy shifts confuse people who were already struggling to understand a complex new system, and they force insurance companies to take on more work, which would be difficult even if everything were going right. The cumulative effect is that at least some people — we hope not many — will misunderstand their responsibilities under the law or be deterred from seeking coverage.

The biggest danger is that the Obama administration is encouraging politicians to meddle in the health-care system every time a few vocal constituents get upset about its requirements. Ms. Sebelius’s Thursday announcement was a response to six Democratic senators from competitive states who are concerned about people getting insurance cancellation notices. Not everyone was going to win under health-care reform, and not everyone can if the system is to work. The threat is that, in seeing to the concerns of those who might have to pay more in 2014 or in future years or some other group that feels put upon at some time, politicians will poke so many holes and add so many exceptions that the law is seriously undermined.