Americans in Need Will Save Obamacare From Itself

Jonathan Bachman/Reuters

Much of the debate about the Obamacare rollout has centered on whether or not its early troubles will turn people off the idea that government can do big things well. But people do not turn to government programs because they believe in them. They turn to them because they need them, and the market is not meeting their needs. When your alternative is not something excellent but nothing, you use whatever is there. A bad lunch is still lunch, an overrun city college is still a pathway to prosperity, and Medicaid is far better than six months of calls from debt collectors.

That's going to save the Obamacare rollout. It's also going to make many people who don't normally deal with government programs for people in need feel uncomfortable as they encounter a level of bureaucratic inefficiency they are unused to. There are two main constituencies for Obamacare: people who don't have insurance, and people who have insurance in the private market already. Both are being funneled into Healthcare.gov, the woe-begone federally-run site for health-insurance marketplaces in 36 states. As Jeff Young at the Huffington Post pointed out this morning, a number of individual-market plans are shutting down now that they must meet higher standards, making it urgent for individual-market buyers to transfer to a new plan through Healthcare.gov or one of the state exchanges before the start of the new year. Meanwhile, the "Obamacare enrollment website remains badly broken despite two weeks of intensive round-the-clock efforts at repairs," according to Politico.

People who have experience with programs for the needy will recognize a familiar bureaucratic incompetence in the rollout. It's a tragedy to watch early efforts to sign up through a new government-mandated insurance access route—as by these working-class Floridians—turn into one more sad chapter in a long book called the humiliations and frustrations of not being well-off in America.

Yet the fact remains that there are uninsured who need health insurance, and they will need it whether or not it is easy to get. Most of these people are already inclined by demographics toward the Democrats, and as they come in contact with the effects of the Affordable Care Act, their views on it have become more positive, according to an October 16 memo from Democratic pollsters. "The biggest shifts on favorability since 2010 come not from partisans but from independents and key groups, including unmarried women, white non-college voters, and seniors. These are also the groups most likely to report that they are seeing the benefits of the law. This is not being driven by partisans aligning their views; this is being driven by the relevance of the changes to people’s lives," observe memo authors Stan Greenberg, James Carville, and Erica Seifert.

The Obamacare rollout is sure to become a legendary case study in high-profile government goofs. But polls show people now oppose the law less than they did just this summer, too.

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Obamacare was damaged at the outset by the political tug-of-war over its very existence, and the conflicts at its creation have had serious downstream effects, placing the federal government in charge of far more than it was supposed to be doing. It also has also suffered from what Johns Hopkins University political scientist Steven Teles calls "kludgeocracy"—the tendency of interest groups, lobbyists, bureaucracy, and bad management to combine to create highly complex legislation and giant public-administration kludges, a term defined as "an ill-assorted collection of poorly-matching parts, forming a distressing whole."

That is what Obamacare is proving to be, though it has its bright spots, too among the 14 state exchanges. The law passed in March 2010, but final rules governing how the exchanges were to work were not issued until March 2013. A bid from the main IT contractor, CGI Federal, was accepted in September 2011, but the company did not start critical work until this spring because it was waiting for specifications from the government, leaving too little time to troubleshoot the enormously complex systems CGI and others were setting up.

The federal government needed to build many more sites than the program was designed for it to do. The law was set up to work state-by-state to respect existing state insurance markets. But Republican governors who opposed the idea of the exchanges and expanding Medicaid, coupled with a Supreme Court decision that they did not have to expand Medicaid, led the federal government to take on responsibility for many more states than it ever planned to do—36 in all. Deep and abiding problems with the federal procurement process meant expertise from Obama's close ties to new-media leaders could not be brought to bear on the project.

As troubles with the customer-facing sign-up process have lessened, thanks in part to a drop in traffic to Healthcare.gov coupled with a furious effort to solve sign-in problems, new tech issues have emerged to threaten the whole system. Problems on the back-end involving capturing customer data accurately, and questions about whether the site can feed accurate data to the insurers, who are now having to manually reconfirm the data they are getting, have sprung to the fore. This week, customers who called the Obamacare help center run by government contractor Vangent were told their passwords had been erased, but a senior administration official denied that and said call-center workers were merely working from an incorrect script that managers had not been able to get them to stop using it a week after the problem was identified.

If the site cannot solve the login and other problems for already-insured people transferring into the market, the new year could see not a win for the administration but a real crisis for those users. And it won't be doing anyone any good if the technical problems with the site scare off so many people—especially young, healthy people who need to be in the risk pools for premiums to stay low—that they forgo insurance rather than deal with the hassles.

Still, Gallup polling shows most of the uninsured, whether they understand the options available to them under Obamacare or not, plan to seek insurance. Ultimately, people in need need whatever there is, and once users get through the websites, they'll either be in a private plan or in Medicaid. And they won't have to tangle with Healthcare.gov or any of the state exchange sites again for at least a year.

Garance Franke-Ruta is a former senior editor covering national politics at The Atlantic.


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