Is the White House Now Thinking the ‘Unthinkable’ about Obamacare?
October 19, 2013 - 8:57 am
This is a brutal assessment of the Obamacare insurance exchange by NRO’s Yuval Levin, who talked to several upper-echelon bureaucrats at the Center for Medicare and Medicaid Services (CMS) as well as some insurance industry people intimately involved in the sign-up process.
After many caveats and qualifiers, Levin describes the panic of those he spoke with regarding just how bad the problems are with the Healthcare.Gov website. Despite round-the-clock attempts to fix the problems, things aren’t getting any better and the prospects for a functional system that could sign up enough enrollees to make Obamacare work are not very good.
Some highlights from Levin’s article that should be read in its entirety to get the full scope of desperation and resignation that he found with the CMS and insurance reps:
What has happened, at least so far, presents itself in several layers. One key problem, which to date has been the most prominent in public, has to do with a late-in-the-game decision to require users to go through a complex account-creation process before even reaching any coverage options. Administration officials apparently went back and forth several times on this question, and the ultimate decision required the creation of a series of patches over an already developed site in a very short time. Most of the problems people have faced so far are a function of that decision, and have had to do with creating user accounts and so getting through the very first steps involved in purchasing coverage. Some journalists and analysts have speculated that this decision was made in order to prevent people from seeing premium costs before they could also see any subsidies they might be eligible for, so that the shock of higher prices could be contained and so that simply curious observers and journalists couldn’t get a picture of premium costs in the various states. This explanation strikes me as plausible, and it struck several of the people I spoke with as plausible, but none of them could confirm it. It may be true, but it’s surely not the only possible explanation. Whatever the cause, that decision has created crippling problems that are still largely unresolved.
This fits right in with the general dishonesty that has been a hallmark of Obamacare from the time it was introduced to the present. They are pathologically incapable of being honest about the deleterious effects of Obamacare on business, on the economy, on the consumer, and on the health and well-being of the American people.
The problems people are now facing with the basic interface have taken up most of the time that CMS and its contractors have devoted to troubleshooting so far, and although things have improved a little on this front quite serious problems remain. But there are very serious problems beyond that, which are more like the sorts of problems people were predicting before the launch: database problems at the nexus of several federal and industry data sources. The federal data hub itself is so far doing reasonably well at its basic tasks, and that has come as a relief to CMS. But some of the site functions that rely on the hub, both in the federal exchanges and a number of the state exchanges, remain highly problematic. The calculation of subsidies continues to fail tests, and it’s pretty clear that some actual consumers have made actual purchases with bad information, which will become apparent to them when they get their first bills. If the interface problems are addressed and the volume of purchases increases, this calculation problem could become a huge concern.
What happens if tens of thousands of consumers get their first insurance bill and discover they’re paying more than they thought? Or get a notice from the IRS that the subsidy they thought they were getting is incorrect? Imagine: pitchforks, tar, and feathers.
CMS officials and the large insurers thought at first that the garbled data being automatically sent to insurers must be a function of some very simple problems of format incompatibility between the government and insurer systems, but that now seems not to be the case, and the problem appears to be deeper and harder to resolve. It is a very high priority problem, because the system will not be able to function if the insurers cannot have some confidence about the data they receive. At this point, insurers are trying to work through the data manually, because the volume of enrollments is very, very low. But again, if that changes, this could quickly become impossible.
Given all of the above, what are the options going forward?
The nightmare scenarios, the “unthinkable options,” involve larger moves than that—like putting enrollment on hold or re-starting the exchange system from scratch at some point. No one seems to know how this could work or what it would mean, but everyone involved is contending with a far worse set of circumstances than they were prepared for. This is a major disaster from their point of view, not a set of glitches, and they simply do not know how long it will take to fix. They dearly want to see progress day by day, but they are generally not seeing it.
The canned response from many on the right is that the system was “designed” to fail or that Obama and the Democrats want it to fail so that a single-payer system can be implemented. It’s an interesting theory but not likely, as Jim Geraghty points out:
This is where you say, “It’s designed to fail! It’s designed to collapse the existing health-care system!” That’s a really compelling theory, but the catch is that it’s got Obama’s name on it and the Democratic party has built just about all of their political capital on the idea that it would work. Democrats would be betting that after completely fouling up their signature domestic policy and one-sixth of the American economy, the voters would trust them to give it another shot, this time making even bigger, more radical, expensive, and complicated changes.
Besides, for the conspiracy to work, a single-payer system would have to get through the GOP House, not to mention needing 60 votes in the Senate. Does anyone believe that after the internal bloodletting over defunding Obamacare there are any Republicans who would vote for their own electoral execution and help pass a single-payer system?
No, this is sheer incompetence, coupled with typical dishonesty from the administration. They may pay for it by owning the biggest boondoggle in American history — the failure of a government entitlement that could discredit the idea of big government for a long time.