Now that the federal government is open again, the attention of the public, media and, of course, politicians, will turn, as it should, to whether the Obama administration will be able to make the glitch-plagued health insurance exchanges work.
I wasn't at all surprised that people were having a hard time signing up for coverage on Oct. 1, the first day the exchanges were supposed to be up and running. Many of the exchanges -- specifically those few that were built and are being operated by individual states -- worked just fine from the very beginning.
But the exchange for most of the states is being operated by the federal government. In reality, regrettably, it is more accurate to say that they are not being operated by the feds because of technology problems, the extent of which we can only speculate.
That's because the White House and the Department of Health and Human Services are not being forthcoming about what's really wrong with the Healthcare.gov website and how and when things will be fixed.
That doesn't give supporters of the Affordable Care Act much comfort. Many are understandably anxious. They're beginning to wonder if the Obama administration really can fix things before Dec. 15, which is the last day of the open enrollment period for individual health insurance policies that go into effect on Jan. 1, 2014.
Instead of sitting down with reporters to explain what's really going on, administration and HHS officials are just issuing pablum -- the kind of statements PR people feed the media when they want to obscure rather than enlighten -- which, of course, gives reporters -- and opponents of Obamacare -- all the more reason to believe that things are much worse than anyone is letting on.
So what happened -- or didn't happen -- to make it the federal exchange so unworkable, at least for now?
Here are four possible reasons for the current mess:
- HHS wasted valuable time trying to persuade more states to operate their own exchanges. Officials apparently deluded themselves into thinking that even some of the red states could be persuaded that it would be in their best interests to have a state-run exchange than one run by the federal government. In hindsight, those officials wasted months in which time and resources could have been devoted to making sure the federal exchange would work on Oct. 1. HHS officials should have realized from the beginning that Republican governors and state legislators had no incentive for Obamacare to work. There wasn't a chance that they would operate their own exchanges if doing so might enhance the chances that Obamacare would be perceived as a success.
- The administration waited too long to issue important regulations pertaining to the law. HHS clearly didn't want to announce some of the more controversial regulations until after the 2012 midterm election. Those postponements decreased the chances that insurers and the companies hired to build and operate the federal exchange could have everything in place and working perfectly by Oct. 1.
- It made a mistake by requiring that visitors to the website first set up an account before beginning to shop for coverage. Some states operating their own exchanges didn't do this, which, again in hindsight, was a wise decision. Setting up the accounts at the front end has proven to be a system-crashing undertaking. Apparently only a lucky few have been able to get through the account set-up phase and actually begin the real process of choosing a health plan.
- There are simply too many moving parts -- and too many health plan options. Not only are there several insurers offering an array of policies in most states, there are four levels of coverage -- bronze, silver, gold and platinum -- all with varying premiums and coinsurance obligations. Members of Congress who wrote the law fell for the insurance industry's propaganda that "choice and competition" are what the American people need and want. No, it is what the insurance industry wants. When people do get past the account set-up phase, they have to spend considerable time trying to make sense of the various choices -- far more than most employers offer their workers.
Beyond those factors, the reality is that building a system in which so many different entities have to communicate perfectly with each other is no small undertaking. It very well might be the most complicated initiative of its kind in the history of computer technology, at least in health care. I remember all too well when more than a decade ago Cigna encountered huge problems when it began moving its policyholders from numerous legacy claim-paying platforms to a new, unified system. The inevitable glitches infuriated many customers. A lot of policyholders didn't get their membership cards on time. It was a mess that cost the company dearly. And that was just one company.
Cigna eventually fixed the problems and recovered. Chances are most of the company's current customers either never knew or don't remember how bad things were for awhile. If the feds can fix the problems with the exchanges within the next few weeks, few people will remember those problems even this time next year. But if they aren't fixed soon, all bets are off.