Quotes of the day

Yesterday, I reported on the troubles I had accessing the new-and-improved HealthCare.gov. The Obama administration today said more than 1 million people accessed the site yesterday and that it was stable for users.

The president likewise touted the site’s performance today, part of a push to promote the law.

So I decided to try the site again this afternoon. This time, I didn’t see the “Please Wait” flags that bogged me down yesterday, but I had a more fundamental problem. When I got to the step of comparing health plans, I couldn’t see any.


In what could become the next major headache for President Barack Obama’s signature domestic policy, a group representing leading U.S. insurers said on Tuesday that technology fixes that will enable millions of people to sign on to HealthCare.gov have not fully addressed faulty data that the site has been sending these companies about their new enrollees…

Daniel Durham, a vice president for policy and regulatory affairs at America’s Health Insurance Plans, a lobby group for health insurers, said companies were regularly receiving faulty enrollment forms. He did not give details on how frequently the errors were appearing…

“It’s a real problem for plans when the enrollment file never comes over, and then you get the consumer calling, and the plan has no record of that individual,” Durham said at a forum organized by Georgetown University and law firm Arent Fox. “Time is short. January 1 is coming around fairly quickly here.”


Although Medicaid sign-ups through HealthCare.gov have been considered a rare bright spot in the flawed Obamacare rollout, the federal portal has been unable to send those Medicaid applications to the states for final processing. If states can’t receive and complete their work on Medicaid applications by the end of the year, people could go without Medicaid coverage in early 2014 despite having an eligibility determination

States are concerned that many of the flat files they’ve received from HealthCare.gov don’t indicate whether applicants have also attempted to enroll in Medicaid directly through a local agency, leaving states vulnerable to duplicate sign-ups. And there’s been no end-to-end testing to gauge potential issues with the information states get. Complicating the issue further is the work many states are doing to rebuild their own Medicaid eligibility systems to align with new Obamacare requirements.


The administration has given up on success, as it might once have defined it. The object is no longer 7 million people signed up through the exchanges, with 2.7 million of them young and healthy, and the health-care cost curve bending back toward the earth. It is to keep the program alive until 2015. The administration’s priorities are, first, to keep Democrats from undoing the individual mandate or otherwise crippling the law; second, to keep insurers from raising premiums or exiting the marketplace; third, to tamp down loose talk about the failures on the exchanges; and, only fourth, to get to the place where it used to think it would be this year, with lots of people signed up for affordable insurance. It is now measuring the program’s success not by whether it meets its goals, but by whether it survives at all. And all of its choices are oriented toward this new priority.

You can see this in the decisions the administration made about fixing HealthCare.gov: It focused on the part that voters can see, even though the part that accurately transmits data to insurers is arguably more important — is it better, or actually worse, to “sign up” a bunch of people when you can’t get that information to the insurers who need to write the actual policies? You can see it in the strategic delays, particularly the delay of the open enrollment deadline until after the 2014 elections. And you can see it in how the administration is treating insurers. As plan cancellations became a big political problem, the administration looked like it was preparing to blame insurers, which has been a very successful political tactic for them in the past. But it quickly walked that back, because with the program’s survival on the line, it needed insurers on board. That’s why the administration is looking to get extra money to the insurers; it’s the sweetener it needs to forbear little things such as possibly not getting accurate enrollment data, or payments, for months.

From the administration’s perspective, this makes a lot of sense. A program that survives until 2015 can hopefully be fixed. A program that is fatally damaged by Democratic or insurer defections definitely can’t.


It’s a shock for most people that it’s a shambles. A fellow very friendly to the administration, a longtime supporter, cornered me at a holiday party recently to ask, with true perplexity: “How could any president put his entire reputation on the line with a program and not be on the phone every day pushing people and making sure it will work? Do you know of any president who wouldn’t do that?” I couldn’t think of one, and it’s the same question I’d been asking myself. The questioner had been the manager of a great institution, a high stakes 24/7 operation with a lot of moving parts. He knew Murphy’s law—if it can go wrong, it will. Managers—presidents—have to obsess, have to put the fear of God, as Mr. Obama says, into those below them in the line of authority. They don’t have to get down in the weeds every day but they have to know there are weeds, and that things get caught in them…

For four years I have been told, by those who’ve worked in the administration and those who’ve visited it as volunteers or contractors, that the Obama White House isn’t organized. It’s just full of chatter. Meetings don’t begin on time, there’s no agenda, the list of those invited seems to expand and contract at somebody’s whim. There is a tendency to speak of how a problem will look and how its appearance should be handled, as opposed to what the problem is and should be done about it. People speak airily, without point. They scroll down, see a call that has to be returned, pop out and then in again.

It does not sound like a professional operation. And this is both typical of White Houses and yet on some level extreme. People have always had meetings to arrange meetings, but the lack of focus, the lack of point, the sense that they are operating within accepted levels of incoherence—this all sounds, actually, peculiar.

And when you apply this to the ObamaCare debacle, suddenly it seems to make sense. The White House is so unformed and chaotic that they probably didn’t ignore the problem, they probably held a million meetings on it. People probably said things like, “We’re experiencing some technological challenges but we’re sure we’ll be up by October,” and other people said, “Yes, it’s important we launch strong,” and others said, “The Republicans will have a field day if we’re not.” And then everyone went to their next meeting. And no one did anything. And the president went off and made speeches.


But within months, it may well be that abstract arguments over the nature of Obamacare will be trumped by the realities of the Affordable Care Act. Eventually, there will be stats and facts to consider: how many people receive insurance through the exchanges, what happens with premiums, the direction of health care costs, customer satisfaction, and the like. Though the results may be open to debate for a while, it is distinctly possible that one side or the other will be proven right (or wrong). If the website functions, millions sign up, and the health care market doesn’t crash, and premiums don’t zoom up—and this will be on top of the already existing benefits of Obamacare, including removing preexisting conditions restraints, allowing young adults to remain on their parents’ policies, reducing out-of-pocket prescription drug costs for seniors, and forcing insurance companies to devote a higher percentage of premiums to health care coverage—where will the Republicans be? Not only will they be failed doomsayers; they will have lost the No. 1 item on their why-you-should-vote-GOP list. Their anti-government crusade will be derailed. They will be a train without a motor.

Should Obamacare not work, then Obama’s vision—which reflects the progressive tradition of the past century—will be a flat tire. He will no longer be able to advance the cause of government activism. Expand Head Start? Create an infrastructure bank? Why should government be allowed (or trusted) to increase its reach? He can talk about helping the middle class. But how? The failed rollout of the website was a problem in so many ways but especially because it suggested that government cannot perform competently. A more extensive failure with Obamacare would suggest that government cannot be used in the manner Obama wishes to see it utilized.

What’s at stake in this never-ending debate over Obamacare are the foundational premises of each party.


As I have said before, the Obama administration is likely in the midst of a four month project to properly fix and test this system. It will likely be at least late January or early February before not just HealthCare.gov but the other key information systems supporting the new law are built and repaired to just minimal standards…

My definition of a fixed HealthCare.gov is a site that encourages enrollment rather than discourages it. Time will tell––but only about three weeks time before the December 23 enrollment deadline for having coverage on January 1.

Maybe, however haltingly, we are finally getting to the main event. The day when people can get a good idea for themselves just what value Obamacare presents for them. The premiums, the deductibles and co-pays, as well as the provider networks. Not just the people who are now uninsured or have had their policy canceled, but also those who don’t need Obamacare today but think they might someday. All of them voters focused on finding out for themselves what this Obamacare thing really is.

Nobody can spin the main event.


Via RCP.


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