No Sign of Plan B for Obamacare
The House Oversight Committee held hearings yesterday on the Affordable Care Act's health-care exchange website with actual Information Technology people, who provided some of the most interesting and informative exchanges to date.
What we didn't learn: whether the site will be ready by Nov. 30, as the administration has promised. (This Washington Postpiece suggests not: "software problems with the federal online health insurance marketplace, especially in handling high volumes, are proving so stubborn that the system is unlikely to work fully by the end of the month as the White House has promised, according to an official with knowledge of the project.")
However, there was more detail, and less faux-technical hand-waving, than we've gotten at other hearings. The most interesting tidbit by far came from Henry Chao, deputy chief information officer at the Centers for Medicare & Medicaid Services, who was heavily involved in the project: According to him, at least some portion of the website still isn't finished, notably the bit that pays insurers. Since that wasn't needed until January, he said, it wasn't finished and tested at the same time as the system. Unfortunately, January no longer sounds so far off.
So, also not optimistic. Yet the White House is saying it's still doable. What to believe? Are they buying time to get a plan together, or are the leaks misinformed -- or misinformation? Could the increasingly dismal sounds we're hearing from the government be part of an amazing public relations effort to deliver a happy surprise in 2013?
Let's hope that it's an elaborate disinformation campaign, because what the administration is going to do if it doesn't work is hard to see. Although pundits are urging it to come up with a workable plan to deliver alongside an announcement that the exchanges will be further delayed, no one has suggested what that plan might be. The whole thing is so complicated that it's hard to come up with a viable alternative to, well, the website working. It's like trying to make your car run without the fuel injection system. Maybe you could do it, if you had enough time. But you'll need to cancel that 7 p.m. reservation at Chez Panisse.
Here are three things to keep in mind:
1. We don't want to let folks renew the cancelled plans, both because it's not clear the insurers can do this at this point, and because this will tend to keep healthier patients out of the market for the new plans.
2. We don't want to delay the individual mandate, because we end up with an insurance pool comprised of old and sick people who have been desperate to buy insurance, and rates go up next year.
3. There's some talk of letting people buy policies direct from insurers. In fact, people can already do this. But this plan has a problem: The law pegs premium subsidies to plans "which were enrolled in through an Exchange established by the State under 1311 of the Patient Protection and Affordable Care Act." Of course, I'm no lawyer, so maybe I'm missing some nuance. But that is how the administration has been treating it: Subsidies are for plans you buy on an exchange.
Yes, the administration has been somewhat, um, flexible with regard to the law's provisions on things like the employer mandate. But there's a limit, and letting insurers sell premiums based on their best guess at your subsidy eligibility seems to push beyond it on all fronts. How are the insurers going to build working subsidy calculators in a few weeks -- ones that don't just give you a reasonable estimate of what you'll pay, but that deliver reliable results you can take to the Internal Revenue Service next year? How will they do this considering that they don't, and can't, have access to IRS data? How will the inevitable cost hikes for taxpayers and pot-sweeteners for the insurers make it through the inevitable political firestorm?
All the obvious stuff seems obviously unworkable. As of now, I haven't heard any un-obvious solutions.
I am sure that right now, people are sitting in White House conference rooms trying to come up with some alternate plan for Dec. 1. (I'm sure this is true even if they still hope it will be fixed.)
But I also suspect that if they had a plan, we would have heard about it by now. Someone would have floated a trial balloon to the press, to see how the public liked it. The absence of a workable suggestion implies that the White House is just as stumped as the pundits.
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Megan McArdle at firstname.lastname@example.org