For the first week that the federal health-care exchanges were running … well, crawling … the Obama administration claimed that no one could get through because of overwhelming pent-up demand. Essentially it spent a week arguing that no one could have predicted that, in a country of 300 million people, 2.4 percent of those people might stop by sometime in the first seven days to check out the administration’s signature legislative achievement.
We can now dismiss that theory, because the administration has: “Six days into the launch of insurance marketplaces created by the new health-care law, the federal government acknowledged for the first time Sunday it needed to fix design and software problems that have kept customers from applying online for coverage.”
Presumably, it would not have given that interview if its efforts to fix the systems had been successful this weekend. The Hill reports that the system will go offline again late tonight for more repairs.
QuickTake: Health Insurance Exchanges
So prepare yourself for the next theory: This is the fault of Republicans. Had Republicans created state exchanges as they were supposed to, agreed to the Medicaid expansion and provided more funding, the reasoning goes, everything would be going swimmingly.
I blame the Republicans for a lot of things, from their support for atrocious farm policies to the counterproductive showdown theater that is: 1. Wreaking havoc on everything from government data websites to the Smithsonian; 2. Not saving any money, because we just agreed to pay furloughed workers; 3. Not noticeably advancing the cause of repealing Obamacare; and 4. Grinding down the public’s opinion of the Republican Party from a stump to a hole.
But I do not think that the Republicans can be blamed for this particular disaster. They did not force the administration to wait until late 2011 to begin awarding important contracts for implementation of the Affordable Care Act. Presumably, they were also not skulking around the Department of Health and Human Services, writing the memos that delayed, until February of this year, the deadline for states to declare whether they’d be running their own exchanges.
I predicted in December 2012 that the exchanges would not be up and running on time with minimal knowledge of how the contracts and budgeting were being run, because the administration was being pretty closed-mouthed about those things. Was I prophetic? Hardly. I just didn’t see how the administration could make things work in the allotted time frame. The development cycle was just too aggressive, even with what my boss used to call a “Shake and Bake” system (take something out of the box, add a few of your own ingredients and roll it out). I thought about the software-implementation projects I’d worked on (not in development but on the server side) back in the days when I was an IT consultant. This seemed a lot faster than anything that any company I’d ever worked with would commit to, even if it had already designed some of the underlying architecture.
And what if Republicans had built state-level exchanges? Do we think that 50 individual state exchanges would now be a shining beacon of hope to the uninsured everywhere? It seems more likely that most of them would also be broken -- again, not because of malfeasance, but because three years is not a long time to design and implement a system of the complexity that the law requires. Many of the state exchanges are still having big problems; they look like they are working only in comparison with the total lockup on the federal exchanges. I’m talking about states such as Maryland and California, which embraced Obamacare. What would they look like in Georgia and Texas? I’m not talking “sabotage,” either; I’m just talking “not anyone’s top legislative or administrative priority.”
In short, the administration passed a law with an unrealistically aggressive implementation schedule. And because of the way it passed it, it had no way to finesse that deadline. The exchanges had to go live on Tuesday no matter how badly they were working -- heck, even if they weren’t working at all and no one had ever managed to successfully complete a test run. Because the alternative was asking Republicans for a delay … and having them enthusiastically agree to put the law off for a minimum of a year, and preferably longer.
Then the administration made things worse by waiting -- waiting to hand out the contracts and waiting to see if it could pick up a few extra states to run their own exchanges. Yes, there was a lot of uncertainty around the Supreme Court case and the midterm elections. And even if you are proceeding with all due speed, writing rules for implementation takes time. But even with those caveats, the administration clearly took a very tight schedule and made things even worse.
So no, this is not a good project undone by Republican “sabotage,” as I saw suggested on Twitter this morning. It’s a potentially good IT project undone by system design and deadlines chosen for political reasons, rather than feasibility. What we’ve been through in the last week, I’d argue, is the inevitable result.
That does not mean that it will never work. We shouldn’t rule that out -- there are nightmare stories of databases in Britain’s National Health Service and Canada’s criminal justice system, which had to be junked after going wildly over budget. But while I assume that’s possible in this case, I don’t think it’s very likely. This system is the linchpin of President Barack Obama’s biggest legislative achievement. The administration is going to try very hard to make it work over the next few months, and I assume that at some point -- in a few weeks, or a few months -- it will succeed.
The real question is whether that will be soon enough to repair the damage. One of the crucial features of the exchange was that its ease of use was supposed to attract “young invincibles” who don’t have insurance now. You’re not going to get too many shots at that customer base before they give up -- and the worse the bugs, the more other, non-invincibles may get worried about giving you their secure data.
The other problem is that the longer the delays go on, the more likely it is that the exchanges really will have load problems when they do get up and running. If everyone has to buy insurance within the space of a few weeks, they might knock the servers down again in much the same way that the administration was claiming they had last week.
But we’re nowhere near that point yet. If the administration can get things together this week, this will probably be quickly forgotten. And if not? Well, any talk about “sabotage” should probably be directed at the administration.