And I do think this tells us something else important: 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.