Of Persistent Obamacare Gremlins and Other Health Care Policy Failures

I presume that this is the “new and improved” Obamacare that everyone is suddenly supposed to be enthusiastic about:

After refusing for weeks to detail the extent of back-end problems with healthcare.gov, the Obama administration on Friday said a technical bug affected approximately 25 percent of enrollments on the federal exchanges in October and November.

Those technical bugs, separate from the troubles consumers had experienced accessing information on the website during the first two months, are posing a significant new problem for those who signed up and are expecting insurance coverage come Jan. 1.

One in four of those applications either did not get transferred to insurers, were transferred in duplicate form, or had major errors in information shared.

Insurers are supposed to receive the 834 Forms from healthcare.gov. The forms, meant to be read by computers, provide insurers with information on enrollees and what plan they have chosen. Without the information, insurers have no way of knowing who has signed up on the Obamacare exchanges and what coverage they need.

Somehow, I find myself unimpressed with these “improvements.” More on this issue from that notoriously right-wing rag, the Huffington Post:

Unresolved technical problems on HealthCare.gov could lead to a rude surprise at the doctor’s office next month for patients who think they successfully used the website to sign up for health insurance. They may find they’re not insured after all.

HealthCare.gov, the federal online portal for health-insurance shopping in more than 30 states, has improved after more than a month of intense fixes, and enrollment is accelerating. But insurance companies are still getting information on their would-be customers that is garbled and incomplete, and in some cases they are getting no information at all. President Barack Obama’s administration is scrambling to repair the faulty system, but scant time remains until the Dec. 23 deadline for consumers to choose a health plan that will be in place Jan. 1.

The result could be an untold number of consumers remaining uninsured despite completing the enrollment process — another embarrassing chapter in the rollout of the Affordable Care Act, Obama’s signature health care reform law.

The Obama administration insists the enrollment glitches will be fixed in time to prevent any troubles next month, but won’t disclose the extent of the problem. Nor will it guarantee that any patients who fall victim to these problems won’t be exposed to medical bills if they get sick or injured.

“I doubt very seriously the insurance company or the government is going to say, ‘Oh, don’t worry, We’ll take care of it.’ I think that’s going to fall solely on the patient,” said Reid Blackwelder, a doctor in Kingsport, Tenn., who is president of the American Academy of Family Physicians. “I wouldn’t count on anybody else jumping in and bailing everybody out.”

To the extent that HealthCare.gov has “improved,” it is only because problems with the website could hardly get any worse. And even after the “improvements,” things remain horrible. I am, of course, not the first to make this point, but when one considers all of the traffic Amazon handled–without any problems whatsoever–once Black Friday and Cyber Monday arrived and the Christmas shopping season went into full swing, and when one compares that kind of near-flawless performance with the problems HealthCare.gov continues to have, one cannot help but be underwhelmed by HealthCare.gov’s performance, even in its “improved” state.

But never fear: David Plouffe says that by 2017, Obamacare “will work really well.” I presume that Team Obama is just itching to make campaign commercials based on that soundbite.

It should be noted that when it comes to technology in general, the federal government is behind the times, which makes one wonder why it was trusted to design and implement a health care website that would help enroll millions of Americans into regional exchanges. It should also be noted–again–that the problems with Obamacare go beyond the flaws of a website:

An estimated seven out of every 10 physicians in deep-blue California are rebelling against the state’s Obamacare health insurance exchange and won’t participate, the head of the state’s largest medical association said.

“It doesn’t surprise me that there’s a high rate of nonparticipation,” said Dr. Richard Thorp, president of the California Medical Association.

Thorp has been a primary care doctor for 38 years in a small town 90 miles north of Sacramento. The CMA represents 38,000 of the roughly 104,000 doctors in California.

“We need some recognition that we’re doing a service to the community. But we can’t do it for free. And we can’t do it at a loss. No other business would do that,” he said.

Remember that according to Paul Krugman, “in California we can see what health reform will look like, beyond the glitches. And it’s going to work.” I don’t suppose that Krugman will have anything to say about the high rate of physician non-participation; it might undermine his narrative if he acknowledged the problem. And does anyone believe that physician non-participation is going to be restricted to California?

I am not the type of person who believes that the solution to a given problem necessarily involves having a lot of meetings about that problem. But what does it say about the Obama administration that it hardly did any legwork to ensure that its signature legislation would be implemented without too many problems?

Journalists and pundits have begun offering lengthy postmortems to explain the causes of the ruinous Obamacare rollout. The debacle’s scale has surprised even progressives who supported the Affordable Care Act. After all, surely three and a half years provided ample time to prepare for a program President Obama calls his “most important initiative.”

Six weeks ago, Obama privately conceded to his advisers, according to the New York Times, “we created this problem we didn’t need to create … and it’s of our own doing.”

So how did it happen? Here’s one theory, backed by new data: not enough meetings.

Amid the Obama administration’s endless rounds of finger-pointing and blame-shifting, scant if any attention has been paid to the amount of time and executive leadership the president personally devoted to implementing his signature legislative achievement.

“Nothing frustrates me more than when people aren’t doing their jobs,” Obama has said. So, with so much riding on the line, one would assume he held weekly, if not daily, one-on-one meetings with his Health and Human Services (HHS) Secretary Kathleen Sebelius to isolate problems, challenge assumptions, apply executive pressure where needed and successfully manage a project of scale.


That did not happen, at least not according to Obama’s own official White House calendar.

Be sure to read the whole thing, including the White House response to the story–which frankly raises more questions than it answers. The president, it would appear, has found yet another entity to blame for the whole debacle–his own government:

President Obama has found someone to blame for the Affordable Care Act’s rolling failures besides Republicans. ObamaCare is the government’s fault, not his.

On Thursday, Mr. Obama dropped by American University for a heart to heart with Chris Matthews, and the MSNBC host wondered who in the executive branch is responsible for the botched health-care rollout. Mr. Obama listed a few impersonal culprits including “cynicism,” “Washington gridlock” and “the management of government,” but he then drifted into another classic.

“The challenge, I think, that we have going forward is not so much my personal management style or particular issues around White House organization,” he said. “It actually has to do with what I referred to earlier, which is we have these big agencies, some of which are outdated, some of which are not designed properly. . . . The White House is just a tiny part of what is a huge, widespread organization with increasingly complex tasks in a complex world.”

So after five years, Mr. Obama has discovered government is inefficient and wasteful, or at least it is when he needs a political alibi.

You know that things are bad when Obamacare supporters believe that in order to save Obamacare, they have to change history. Ezra Klein attempts to do just that by claiming that Obamacare’s “real promise” is that “if you lose your health-care plan, you can get a new one.” Umm . . . no. Relatedly, someone should inform Klein that we have Google and we aren’t senile, which means that we aren’t going to fall for efforts to rewrite the past and to flush the actual promises made by the president and his supporters down the memory hole.

Klein’s efforts to alter the memories of the masses are only slightly more convincing and credible than the Obama administration’s efforts at damage control. As for the political fortunes of the Democratic party . . . well, anything can happen between now and the midterm elections next year. But right now, things don’t look good:

Most graphs of polling data show shifts that are very gradual. (Tracking real-time changes in poll results often is about as exciting as watching paint dry.) Recently, however, the HuffPostPollster website produced a graph of national polling on Congress that showed one of the most dramatic shifts I’ve ever seen in 40 years of involvement in politics. It charts responses to the question of whether voters would like Republicans or Democrats to control the House.

The year began with Democrats 8 points ahead of Republicans on the generic congressional ballot test, 46 percent to 38 percent. The GOP had come out of the 2012 elections licking its wounds, having lost a presidential election that, just a year earlier, appeared highly winnable. As the year progressed, the Democratic advantage gradually but consistently declined, paralleling a similar erosion of President Obama’s job-approval rating since his reelection. The drop in Democrats’ numbers leveled off in June, to a statistically insignificant 1 percentage point lead over Republicans. It is important to remember that there is a historic tendency for this poll question to skew by a couple of points in favor of Democrats, making that meager edge almost certainly an illusion.

Then, in August, statements started coming from some of the more exotic Republicans in the House and Senate that perhaps it was a good idea to shut down the government over the implementation of the Affordable Care Act. Notwithstanding warnings from House and Senate Republican leaders and experienced (and wiser) members that such an effort would be a disaster for the party, the Republicans in the “kamikaze caucus” barreled ahead, over the cliff, shutting down the government.

Sure enough, the Democratic numbers in the generic ballot began to pull dramatically ahead, resembling a steep ascent up the side of a mountain, ending about 7 points ahead of Republicans, 45 percent to 38 percent—an advantage that, were it to last until the election, would give Democrats a chance to recapture the House.

Then, in mid-October, the focus shifted from the government-shutdown fiasco to a different debacle, this time a Democratic disaster: the botched launch of the Obamacare website and subsequent implementation problems of the health care law, including termination notices going out to many people who had insurance coverage. The Democratic numbers from the generic-ballot test dropped from 45 percent to 37 percent, and Republicans moved up to 40 percent. This 10-point net shift from a Democratic advantage of 7 points to a GOP edge of 3 points in just over a month is breathtaking, perhaps an unprecedented swing in such a short period. Occurring around Election Day, such a shift would probably amount to the difference between Democrats picking up at least 10 House seats, possibly even the 17 needed for a majority, and instead losing a half-dozen or so seats.

Just when you think we have explored all of the policy consequences that attend the Obamacare implementation failure, along comes this to show us that the situation is even worse than we realize:

I owe Mitt Romney an apology.

During the 2012 Republican presidential primary season, I repeatedly criticized Romney — and personally challenged him during his editorial board meeting with the Washington Examiner — for promising that if elected, on day one of his presidency, he would grant Obamacare waivers to all 50 states.

As I reported, under the text of the law, the ability to offer waivers to states was subject to many restrictions and wouldn’t even be an option until 2017, four years after his hypothetical swearing in.

Though I still believe I was right about what the statute said, as it turns out, I was being old-fashioned by taking the letter of the law so literally.

Having watched President Obama and Secretary of Health and Human Services Kathleen Sebelius over the past several months unilaterally alter or outright ignore major portions of the law, I now believe that a future Republican president would have greater latitude to gut Obamacare than I once thought possible.

It ought to go without saying that if a future Republican president does what the current Democratic president is doing, cries of “imperial presidency” will be raised anew from people whose tongues currently appear to have been kidnapped by cats.

I recognize that this has been quite the depressing post, so let me close with this. You know, to cheer people up:

“And I will also note that there are 150,000 million different families that get their health care through their employees,” [Harry] Reid said. “So should all federal employees, although under Obamacare, my insurance costs me about $4,500 more that it did before. Yes, because it is age-related and it wasn’t like that before.”

(Emphasis mine.) Couldn’t happen to a nicer guy.

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