Last night brought two significant pieces of news in the saga of the Patient Protection and Affordable Care Act’s health insurance exchanges.
The first is that the government is delaying the second-year start of enrollment for health plans until Nov. 15, 2014. Various rationales have been suggested for this, but to me the most plausible explanation is that the administration does not want consumers finding out their health-care costs until after the midterm elections. Practically speaking, this is a terrible idea: It leaves millions of consumers only a month to get on the website and select a new plan to cover them by Jan. 1, 2015 (to allow for administrative processing, you generally need to buy next month’s insurance by the 15th of the current month). And substantively, it’s outrageous. The government seems to be making things harder on consumers in order to prevent them from having vital information about their health-care system before they go to the polls on Election Day.
This also tells you something about the state of the exchanges and enrollment. The law’s boosters say this is necessary because the young healthy people probably won’t enroll until late March (the administration has already delayed the cutoff for complying with the mandate to March 31, from Feb. 15). We need to delay open enrollment, they say, so that insurers can factor all those young and healthy people into their premium calculations. Preliminary rates for October generally get filed in the spring, so a month delay will allow them to price insurance with a fuller picture of the total pool.
But if the government thought that insurance buyers were likely to have a happy surprise on Nov. 15, I suspect they’d have found reasons to open up enrollment on Oct. 15, as planned. The events of recent weeks have badly damaged President Barack Obama’s political fortunes, and if the Democrats suffer a big loss in the midterms, Obamacare suddenly looks much less secure. What the administration is mostly expressing is a fond hope that everything will be better by March. Which is, to be sure, entirely possible.
That’s where the other piece of news comes in: The House Energy and Commerce Committee just released a series of memos sent around by the implementation team days before the site went live. If you’ve ever worked on a tech implementation, the contents are fairly amazing: The weekend before its debut, the site couldn’t handle even a modest number of simulated users, much less the tens of thousands that the system could be expected to serve on opening day.
I sent the link to my favorite developer, who works on large Internet projects. “Seems fairly standard stuff,” he wrote, “for a system that's launching in a quarter or two (or which is about to slip that much).” And for a system that is being introduced on, say, Tuesday? “Launching like that is just lunacy, and makes you wonder just how strong the reality distortion field is between them and Obama.”
Pretty strong, obviously, or Obama would have -- angrily, regretfully, sorrowfully -- conceded to Republican demands for a one-year delay. If I had to guess, I’d imagine that the tech people laid out the awfulness in great detail, which to them sounded like “Stop, you fools, you’ll kill us all!” and to the policy folks sounded like “Gee, I sure wish we had another couple of months for testing.” This is not uncommon when technical people communicate with nontechnical people.
Which is not to let the policy folks off the hook; from all the reporting that’s been done, they were clearly determined not to hear that it would be best to delay.
That’s water under the bridge. The real question is what this tells us about the future. And what both pieces of news seem to tell us is that it’s not very likely that the system will be working seamlessly on Nov. 30. As my developer friend points out, fixing a system that has already been opened is harder than fixing one that’s still in development; once you’ve started, user data need to be protected and dealt with, and people from your team need to be diverted to support the live product. Indeed, during yesterday’s conference call with the Department of Health and Human Services, the administration seemed to have given up on the Nov. 30 date; it said that this would be a process, not a “big bang” where everything is suddenly fixed.
This is obviously not good news. I’m starting to wonder if we aren’t approaching the point where the extended malfunction will irreparably damage the Obamacare brand. As a marketing message, “Sign up for Obamacare: It’s working now, unlike the last five times you tried it” lacks a certain je ne sais quoi.
I’m not quite ready to call doom yet; Medicare Part D had a rocky start, and now it’s quite popular. On the other hand, the rocks weren’t quite this big, and they didn’t stretch on for quite so long.