But I do not think that the Republicans can be blamed for this particular disaster. They did not force the administration to wait until late 2011 to begin awarding important contracts for implementation of the Affordable Care Act. Presumably, they were also not skulking around the Department of Health and Human Services, writing the memos that delayed, until February of this year, the deadline for states to declare whether they’d be running their own exchanges.
I predicted in December 2012 that the exchanges would not be up and running on time with minimal knowledge of how the contracts and budgeting were being run, because the administration was being pretty closed-mouthed about those things. Was I prophetic? Hardly. I just didn’t see how the administration could make things work in the allotted time frame. The development cycle was just too aggressive, even with what my boss used to call a “Shake and Bake” system (take something out of the box, add a few of your own ingredients and roll it out). I thought about the software-implementation projects I’d worked on (not in development but on the server side) back in the days when I was an IT consultant. This seemed a lot faster than anything that any company I’d ever worked with would commit to, even if it had already designed some of the underlying architecture.
And what if Republicans had built state-level exchanges? Do we think that 50 individual state exchanges would now be a shining beacon of hope to the uninsured everywhere? It seems more likely that most of them would also be broken — again, not because of malfeasance, but because three years is not a long time to design and implement a system of the complexity that the law requires. Many of the state exchanges are still having big problems; they look like they are working only in comparison with the total lockup on the federal exchanges. I’m talking about states such as Maryland and California, which embraced Obamacare. What would they look like in Georgia and Texas? I’m not talking “sabotage,” either; I’m just talking “not anyone’s top legislative or administrative priority.”