The Obama administration just rolled out what could be called "version 1.1" of HealthCare.gov, the website set up as a health insurance exchange for Americans who live in states which didn't set up their own state-level exchanges. In the computer world, "version 1.1" normally means "the first bug-fix version" of a piece of software. After two months of nothing short of disaster, the White House is now confident that the website is ready for prime time. Mostly.
The next few weeks will prove them either right or wrong. But the interesting thing (if the website does work well) is that the political conversation may soon shift to a debate we should rightfully have had three or four years ago, but which has never adequately taken place: arguing the relative benefits and drawbacks of the Patient Protection and Affordable Care Act (the proper name of "Obamacare"), rather than the endless strawman arguments that have flooded the discussion from the get-go.
Before we get to all the politics, however, it is worth examining the remaining hurdles which must be cleared before HealthCare.gov (ver. 1.1) can be realistically called a success. December is going to be a critical month for the site, both in generating results and in the public's perception. Part of the problem with both of these is the way the White House decided to release the data. Understandably, they wanted people to take a longer view than the one in the media during the first month of the website's operation. To further this end, they decided to only release the sign-up numbers on a monthly basis (rather than weekly, or some sort of rolling total). To date, we have only had one set of hard data to examine. The October numbers were released in mid-November, and (as expected) they were pretty dismal. The November numbers will be released within a week or two, and they will likely be less dismal but still not very impressive. The website still had major problems throughout November, so this is also to be expected.
In October, a little over 100,000 people successfully signed up for new health insurance via the federal HealthCare.gov site and also through individual state sites (from states which set up their own). There's a leak of November data in the news today which shows (if accurate) that 100,000 people may have signed up through the HealthCare.gov site last month, which would roughly quadruple the number of people who did so in October. Scaling this up, perhaps the final November number (with the individual state data added in) will top 400,000. That's more impressive than the October number, but it's still far short of what is needed for success. Before the website launched, the estimate from a number of sources was that 7,000,000 people needed to sign up for health insurance on the exchanges in the first six months for the marketplace to work as designed. We are now two months in to that six-month period, and only an estimated 500,000 people have signed up. To put this another way, we're one-third of the way through the period and only one-fourteenth of the way towards the goal. What this means is that to hit that goal an average of 1,625,000 people must sign up in each of the remaining four months -- a tall order indeed, when compared to the first two months.
But this is, of course, somewhat of an unfair comparison. In October and November, the website wasn't working well (if at all). So millions of people decided it would be worth waiting until the website was up and running. In addition, many Americans are serial procrastinators, and wouldn't have signed up "until the last minute" anyway. There are two such "last minute" deadlines built into the system. One arrives in December, and the other comes at the end of March (the end of the initial sign-up period). The first is to sign up for health insurance so that you'll be covered on the first of January. The second is to sign up for health insurance by the final deadline so that you won't have to pay a penalty on your 2014 income tax form. The first deadline is important to people who actually have health insurance now and don't want to have any gap in their coverage. The second deadline is more important to the people who don't have health insurance yet, but are putting off actually buying it until the last minute. So there are two built-in "spikes" which should happen (as, indeed, happened in Massachusetts when Romneycare began).
The first of these spikes should be starting right about now. I predicted this traffic spike a few weeks ago, and warned that successfully handling even 50,000 simultaneous users might not be anywhere near enough capacity to meet the spike in demand. The 50,000 number was the original specification for the website, which may have been a very low guess when all the spike traffic is taken into account. The White House is reportedly a little worried about this now, as evidenced by their so-called "soft" rollout of version 1.1 of the website -- President Obama hasn't gone out and confidently invited all and sundry to use the site this week, because they are worried about all the pent-up demand from the two-month wait.
But they have at least come up with a pro-active solution. Whether it works or not is anybody's guess, at this point, but at least there is a built-in safety valve this time around. If the website is being overwhelmed, then everyone at the back of the line will be told to come back later, complete with a system to inform you when you will be at the front of the queue and not the back. This could work well, as anyone who has ever visited a deli can attest. Waiting in line will not require you to sit at your computer, constantly refreshing your screen, but instead being told "come back in X hours" or by an email which informs you "you're now at the front of the line, please log on." The fix may be slightly inelegant (compared to everyone being served at once), but it's a lot better than a frozen screen or an error message. We'll be able to see if this works well or not in the next week or two.
December will be a critical month for the website, one way or another. If the spike is handled well, then the number of people who have signed up will climb fast (even though we won't know that number until mid-January). If not, then Democrats will likely jump ship and join with Republicans to push back the implementation of the individual mandate for a year. This will, obviously, hand the Republicans a gigantic political victory. Not only will the website's woes (both versions 1.0 and 1.1) be a total laughingstock, but Republicans will gain exactly what they tried to shut the government down over -- a one-year extension of the full implementation of Obamacare. The secondary effect of this will be that they'll be able to campaign on it throughout the 2014 midterms, without much evidence to contradict whatever claims they feel like making about the program. Obamacare (at least for the campaign) will be reduced to a cheap laugh line.
On the other hand, if the website starts working well, then the conversation is going to pivot in a big way. Because if they don't have the website troubles to kick around any more, then Republicans are going to move on to picking apart individual aspects of the law itself (they've already shown indications of making this pivot). The stories of people "getting kicked off their insurance" are going to fade (as the same people will now be able to actually see their choices on the website, debunking a lot of the horror stories which have been circulating). But they will be replaced. Republicans have already been actively seeking stories of woe from people unsatisfied with some piece of Obamacare or another, and they will continue these efforts with a passion, well into 2014. They have doubled down on the "Obamacare cannot succeed" position, to be blunt.
But Democrats should take heart -- if the website works well in December -- because this will shift the entire debate onto political ground which isn't just more friendly to them but actually is tilted heavily in their direction. Because this will be the turning point to the discussion about what is actually in Obamacare, as opposed to the boogeyman stories Republicans have been telling for years. Republicans will no longer be able to get away with sweeping statements about how Obamacare will "end civilization as we know it" (or whatever strawman they're peddling), because hard data will soon exist to show this to be the nonsense it always was. Sarah Palin won't get much traction talking about how a "death panel" is going to vote on whether her baby is worthy enough to live or not, because Americans will be able to look around and see that this is nothing short of moose poop.
Republicans will adapt, of course. But they'll be adapting to reality this time. They'll bring up this aspect or that of Obamacare which is not working, and they'll demand it be changed. But they likely won't be talking about a "full repeal" of Obamacare any more, because that would mean denying health insurance to millions who have already signed up for the first time ever. "Repeal" will be replaced with "reform."
Which should be just fine with Democrats. Because there isn't a Democrat alive who would argue the position that "Obamacare is perfect, not a single thing can ever be changed in it." Democrats have always been open to the concept of making Obamacare work better, in fact. They may not agree with Republicans (or even among themselves) what "making Obamacare work better" means, exactly, but the hardline position of "it can't be changed, ever" doesn't even exist within the Democratic Party.
This is why the playing field will shift to one which favors Democrats. Democrats will be able to force Republicans to finally admit that there are good things contained within Obamacare. They've already shown signs of backing down on things like "pre-existing conditions" and children staying on their parents' insurance longer. One by one, the other positive aspects of Obamacare will become non-controversial for the sole reason that Republicans will see how popular they are, and then abruptly stop talking about them. Republicans will be reduced to nitpicking around the edges. Democrats can then feel free to speak of the good things which Obamacare has delivered (with plenty of their own examples to back such statements up), while showing flexibility on serious proposals for positive reform of the law. And if they're feeling feisty, Democrats can compile a list of talking points of all the evil things Republicans have fear-mongered upon in the past few years which have not come to pass.
Republicans are expecting and planning on campaigning on the idea that "Obamacare has failed in every way," but this could morph throughout the year to become "we have to fix these minor problems with Obamacare," which is not nearly as scary. Democrats, however, will have to make their own case as well -- they can't just sit back and ignore the issue. They'll have to repeat the good things about Obamacare at the start of any discussion, and then argue individual parts of the program on the merits. This shouldn't be hard, because this is the debate Democrats have wanted to hold all along. They've been waiting for the air to clear on all the fear-mongering and to discuss actual policy rather than boogeymen. Now will be their chance to finally do so. But since the "Obamacare must not be changed one tiny little bit" caricature of Democrats is a false one, individual Democrats will be able to easily say: "I'm glad that Republicans are finally focusing on positive changes and reforms we can make together, rather than just trying to destroy the law at all costs. I welcome such long-overdue reasonableness, in fact." This could tilt the issue in the 2014 campaign in a big way.
Of course, this assumes that version 1.1 of the Obamacare website has actually fixed the problems and that the site works well throughout December -- which is a fairly large assumption to make, at this point. Time will tell.
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