Excruciating fun from this morning’s House hearing with CMS director Marilyn Tavenner, who apologized for the Healthcare.gov apocalypse and then claimed that “we have a system that’s working,” just not quite at the speed she’d hoped. I guess that’s true, technically. If 15 people are enrolling a day instead of the 15,000 they’d hoped for, the system is still kinda sorta working. Feel better?
A few days ago, HHS announced that 700,000 people had already applied for coverage under ObamaCare this month. Great! HHS’s target was 500,000. It’s a smash success, no? Well, no: HHS’s target was 500,000 enrollments, not applications. Not everyone who’s applied has enrolled, and given the tech problems on the back-end of Healthcare.gov, some untold number of applications are almost certainly misfires created by the site’s buggy processing. Likewise, that “700,000” number includes applications filed on the state exchanges, and some equally untold number of those are actually applications for Medicaid. The adverse selection problem that’s looming next year is a function of people signing up (or not signing up) for private insurance, not Medicaid. Which is why Tavenner’s so quiet here. She must have some idea of whether they’re in the ballpark of hitting the 500,000 mark needed to avoid adverse selection fallout. The fact that she’s not ready to say so yet speaks volumes.
Economist Tyler Cowen imagines what’s coming:
4. Come January 1, hundreds of thousands of Americans will lose their individual coverage packages for not meeting ACA standards. Most of them won’t have ready replacements. This will be a big mainstream media story, not just a FoxNews story. There will be easily identifiable victims, expressing sorrow or rage or both in front of the camera. Left-wing bloggers will express outrage that Republicans express outrage over the existence of individuals with no insurance coverage. Republicans will express outrage that left-wing bloggers express outrage, etc.
5. Democrats will propose various ACA fixes, and Republicans will reject them, claiming that the law requires a more fundamental restructuring. That standoff will not be readily resolved and it will become the “new debt-ceiling crisis.” Democratic defections will be a problem for Obama.
6. The exchanges will be mostly working by March 2014, but by then the risk pool will be dysfunctional. In the meantime, real net prices will creep up, if only through implicit rationing and restrictions on provider networks. The Obama administration will attempt to address this problem — unsuccessfully — through additional regulation.
7. By October 2014, no one will think the exchanges are a satisfactory solution, except for 17 state exchanges which will be running reasonably well. Some of the state-level exchanges, by the way, will have more serious problems than is currently evident, mostly on the back end.
Follow the last link to see what the eighth and final step is. Exit question: Why would HHS hold onto the enrollment numbers until November, when panic about the website will be at a fever pitch? If you have bad news to tell the country about the law not working, dropping it while the media’s watching to see if Healthcare.gov can be salvaged in the nick of time (spoiler: it can’t) is the worst possible time to do it. It’ll only compound the sense of catastrophic failure.