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Obama defends Affordable Care Act

President Obama tells volunteers in Dallas that despite challenges in implementing the Affordable Care Act, families in Texas will have access to affordable, high quality health insurance, vowing "to get this done." (Reuters)

President Obama is at work this week rallying support for the Affordable Care Act, also known as Obamacare. A frustrating launch for the law’s online marketplaces, along with cancellations for many policyholders, has emboldened critics. In Texas on Wednesday to raise funds, the president urged his audience to be patient:

“As challenging as this may seem sometimes, as frustrating as may be sometimes, we are going to get his done,” Obama said.

The visit also cast a bright light on staunch opposition to the law in Republican-leaning Texas, which has the highest rate of uninsured Americans — more than 23 percent. But GOP Gov. Rick Perry and the Texas Legislature have refused to take advantage of a provision in the law to expand Medicaid to cover more of the working poor.

Obama said Texas’ neighbors had looked at the Medicaid expansion, which is fully funded by the federal government for the first few years, as a no-brainer.

“Why wouldn’t the state of Texas want to do the same thing?” he asked later at a fundraiser for the Democratic Senatorial Campaign Committee. “Well, it’s because ideology has taken precedence over common sense and helping people.”

Associated Press

Although the Web site’s bugs have prevented many people from buying insurance, the law is unlikely to fail in the long term for that reason, say Wonkblog’s Ezra Klein and Even Soltas:

No one is quite sure how bad’s problems are. The result is no one is quite sure what Obamacare’s “worst-case scenario” is. But in some corners of the media, a grisly consensus is emerging: It’s a “death spiral.” . . .

The key to a “death spiral” is “the spiral” part. Once it reaches a certain point, it becomes self-reinforcing -- and almost impossible to stop. Could that really happen to Obamacare?

Probably not. Obamacare is protected from an actual death spiral by interlocking failsafes. Some kick in if not enough healthy people sign up. Others give healthy people reasons to sign up. Others make sure insurers don’t raise premiums too fast. But together, they offer substantial protection against an actual death spiral.

Ezra Klein and Evan Soltas

Earlier this week, one bureaucrat at the agency responsible for building the troubled Web site resigned:

Tony Trenkle is the chief information officer at the Center for Medicare and Medicaid Services, the agency that built the Affordable Care Act’s online portal. He is in charge of Henry Chao, a deputy chief information officer at Medicare whose name came up in congressional hearings as the source of key decisions.

Trenkle has pretty much spent his entire career in government, according to his biography on the Medicare Web site. His resume includes posts at Medicare, the General Services Administration and the Social Security Administration.

“Our chief operating officer announced yesterday Tony has accepted a position in private sector,” Medicare spokeswoman Julie Bataille told reporters this afternoon. “We’re certainly grateful to his service here. We’ve moved quickly to fill this position.”

Bataille did not response to reporters’ questions of whether Trenkle had been asked to leave the agency. When pressed on this point, she responded, “Tony made a decision that he was going to move to the private sector and that is what our COO announced yesterday.”

Sarah Kliff

Another source of consternation as Obamacare is implemented has been that some people in the individual insurance market have been forced to move to new policies. Glenn Kessler writes that this was an entirely predictable consequence of the new law:

President Obama, in trying to tweak his original pledge, added this caveat earlier this week: “If you had or have one of these plans before the Affordable Care Act came into law and you really like that plan, what we said was, you could keep it if hasn’t changed since the law’s passed. You’re grandfathered in.”

But there’s an interesting wrinkle to this story that few appeared to have understood. The main culprit is not whether or not the insurance industry has changed a plan that ran afoul of the administration’s regulations — but the law’s effective date. . . .

The law has an effective date so far in the past that it virtually guaranteed that the vast majority of people currently in the individual market would end up with a notice saying they needed to buy insurance on the Obamacare exchanges.

The administration’s effort to pin the blame on insurance companies is a classic case of misdirection. Between 75 and 95 percent of the problem stems from the effective date, but the White House chooses to keep the focus elsewhere.

Glenn Kessler

For past coverage of the implementation of Obamacare, continue reading here.

Max Ehrenfreund writes for Wonkblog and compiles Wonkbook, a daily policy newsletter. You can subscribe here. Before joining The Washington Post, Ehrenfreund wrote for the Washington Monthly and The Sacramento Bee.

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