Obamacare was always going to be a major issue in the mid-term elections, since so many of its major pieces — the new health coverage, the online marketplaces where the coverage is available, the expansion of Medicaid, and the hated individual mandate — become real in January.

But now, Democrats will also have to talk about a federal health insurance website that barely anyone can use. Even White House spokesman Jay Carney was reduced to arguing Thursday that Obamacare isn’t just a website — after Obama has been saying it would be as easy as shopping for flat-screen TVs online…

“If the website isn’t fixed soon, it’s not just a Republican issue. Everyone’s concerned,” said Tim Jost, a law professor at Washington and Lee University who’s a vocal advocate of the law. “I don’t see this as just a political problem. I see this as a real problem for millions of Americans.”

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Two weeks after the launch of the Michigan Health Insurance Marketplace, it’s still unclear how many Michiganders have been able to buy insurance there.

Comments earlier today by the chief deputy of the Michigan Department of Insurance and Financial Services underscored the lingering confusion over health insurance exchanges, the centerpiece in each state of the federal Affordable Care Act.

Ann Flood, who on Nov. 1 will become the director of the department, said she checked with her staff and “we actually do not have any confirmation of anyone (in Michigan) signing up on the exchange.”

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Now that we’re two weeks into open enrollment, and shoppers aren’t facing much luck actually enrolling, there’s chatter among health wonks about what that means for the sign-up period: Could it get extended? The individual mandate delayed? Some other option?…

If the problems happening now though persist until the end of the month, that’s when you might see more serious talk of policy changes that give people more of an opportunity to sign up.

“We clearly have one important deadline here, which is December 15,” says Ron Pollack, president of Families USA. “They have to be fixed prior to that, so people can get enrolled in January. That means if we haven’t seen very substantial progress before the end of this month, that’s worrisome.”

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But insurers are focused on a much earlier date: Jan. 1. That’s when the insurance plans will start to become active. The nightmare scenario for insurers would be if, at the beginning of the new year, they are bombarded by complaints from consumers who, based on information displayed on the federal website, were expecting a certain set of benefits that don’t correspond to the plans to which they signed up.

This doesn’t even get to the broader health policy issue. The success of Obamacare hinges on the exchanges being able to enroll enough young and healthy individuals to offset the cost of covering older and sicker patients, particularly those with pre-existing conditions.

Given that Americans with higher medical costs are more likely to endure an arduous enrollment process than healthier individuals, sustained technological problems could be devastating to the program.

Right now, there isn’t enough data available to say whether insurers are achieving the right mix of enrollees.

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Healthcare.gov is a colossal, expensive failure that projects a 1970s-era DMV experience into cyberspace. It wasn’t for lack of money. As The New York Times reports in a devastating anatomy of failure, some $400 million has been spent so far in creating “a one-stop click-and-go hub for citizens seeking health insurance.” But rest easy, America, since the Times cites a source who says that “the project was now roughly 70 percent of the way toward operating properly.” And the other 30 percent, which is kinda sorta important? “I’ve heard as little as two weeks or as much as a couple of months.” Which is to say, don’t go skydiving or skiing come January 1, 2014

Eventually, the crowd at healthcare.gov will thin out, either because fed-up folks—especially the “young invincibles” who are so important to any chance of the program’s success—stop going there or because the government hires some decent programmers. Whether it’s in two months or 12—and whether it costs another $400 million—is anybody’s guess. But while you’re waiting, consider this: The Congressional Research Service found that the Obama administration missed half of its statutory deadlines for the implementation of The Affordable Care Act in its first three years.

There’s no rush. After the program becomes fully operational, then the real troubles will begin. Who in their right mind is going to feel comfortable giving income and other personal information to a site that inspires less sense of security than a Russian mail-order bride website? The government’s super-spy outfit—the National Security Agency—allowed a short-term contract employee to walk out with a bazillion incriminating PowerPoint slides. And you’re asking us to believe that HHS is going to keep things confidential?

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Gallup’s tracking suggests little progress has been made in uninsured Americans’ awareness of the insurance requirement or familiarity with healthcare exchanges in the weeks since they have been open. On the positive side, more than seven in 10 uninsured Americans are aware they need to get insurance. However, the same percentage say they are unfamiliar with the exchanges, the primary place uninsured Americans are supposed to be able to find insurance.

gal

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The U.S. individual health insurance market currently totals about 19 million people. Because the Obama administration’s regulations on grandfathering existing plans were so stringent about 85% of those, 16 million, are not grandfathered and must comply with Obamacare at their next renewal. The rules are very complex. For example, if you had an individual plan in March of 2010 when the law was passed and you only increased the deductible from $1,000 to $1,500 in the years since, your plan has lost its grandfather status and it will no longer be available to you when it would have renewed in 2014.

These 16 million people are now receiving letters from their carriers saying they are losing their current coverage and must re-enroll in order to avoid a break in coverage and comply with the new health law’s benefit mandates––the vast majority by January 1. Most of these will be seeing some pretty big rate increases.

But unless they live in Washington state, Nevada, Colorado, and Kentucky, they can’t now get on an exchange site to see their plan options, new prices, and provider directories so they can make an informed decision before they lose their coverage.

This is a fine mess.

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Obama, no doubt, wants to avoid the political embarrassment of a delay — or even the mere suggestion of one. But what happens if it’s the middle of December and enrollments are nowhere near where they need to be to make the system viable? What if, by necessity, he has to seek a delay?

The operating assumption would be that Republicans would jump at the chance to delay it. But after the past few weeks, can we really be sure that this would be the case?

It’s perfectly conceivable that if such a scenario played out, the position of the Tea Party activists and their allies in Congress would be that delaying the law for a year would be tantamount to a bailout of Obamacare.

If Obama doesn’t agree to full repeal, they could argue, the law should go into effect and destroy the private insurance market so that Americans can experience the full disaster of the law and increase the public pressure to repeal it entirely.

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Keeping in mind that the pressure for delay will be intense from the states where exchanges are not functioning a month or more from now – which would likely include every state in the federal exchange – and that insurers will insist that they can’t delay the mandate without also delaying the goodies (pre-existing, community rating, etc.), there are a couple of things that I think could come next. Here are, broadly speaking, five different scenarios:

1. The White House could call for/implement via executive order or some other unilateral step a real delay of the individual mandate, just owning the problem or framing it as “we won’t enforce the penalty for 2014″ (likely bringing on a lawsuit from insurers, unless you find a way to make them whole)…

5. POTUS, convinced that he’s in a powerful position in the wake of the shutdown, could refuse any and all delays and privately threaten any Democrats who consider proposing them. Obamacare is the law of the land.

Which of these are we likeliest to see? I expect options 1 and 5.

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Of course it’s possible this nightmare will not happen. Things will get ironed out somehow.

But if they don’t, who’s responsible? First, a president who is not much interested in how government works on the ground. As a community organizer he never did get all the asbestos removed from the Altgeld housing project…

Third, government IT procurement rules are kludgy. Apple didn’t bid on this. The IT work went to insider firms that specialize in jumping through the hoops and ladders of government procurement rules…

[I]f Obamacare’s software crashes, the consequences will be catastrophic — for the nation and for the Democratic Party.

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Via the Examiner.

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