The American Interest
Analysis by Walter Russell Mead & Staff
Ezra Klein on the ACA: "The Magnitude of This Failure Is Stunning"

obamacare

The third week of enrollment in the federal exchanges opened with these strong words from one of the ACA’s biggest supporters, Ezra Klein: “So far, the Affordable Care Act’s launch has been a failure. Not ‘troubled.’ Not ‘glitchy.’ A failure…The magnitude of this failure is stunning. ”

Klein offers five takes on the ACA’s persistent rollout problems, making two especially crucial points. First, as we’ve said before, Klein notes that in shutting down the government, the GOP may have made the most self-defeating political move in recent memory. Without the shutdown, the ACA’s failures would be all news, all the time, and the GOP would be sitting pretty while anger with the law skyrocketed. As things stand now, not only is the public distracted from the ACA; many Americans who have experienced the problems with enrollment may think the law is only malfunctioning because the government is shut down.

Klein also thinks that there could be glitches that haven’t even become public knowledge yet, and if so, this trainwreck of a rollout could extend much longer than many have predicted. So far registration has been most problematic, but once those get resolved and more people create accounts and shop for insurance, the backend of the site through which that information gets communicated to insurers might start failing. Moreover, many people who think they have signed up for insurance might not actually have done so. Just how long these problems will extend is the million dollar question.

What Klein doesn’t do is put these two pieces of information together. The best case scenario now for the GOP may be that the shutdown gets resolved this week or next week, and the ACA continues to fail. Based on what the insurance insiders Klein quotes are saying, the ACA’s continued malfunctioning seems likely. The House failed to pass a new compromise to end the shutdown and extend the debt limit that had been proposed this morning. It would have scrapped the medical device tax and forced all members of Congress and the cabinet to get insurance through the exchanges without an employer subsidy. It’s not clear now what the House will do, but if something like that plan eventually does pass, and the shutdown ends, the ACA’s failures could move to center stage.

At that point, the new costs and premium rates could join the technical failures in creating the kind of opposition to the ACA that the GOP could already be enjoying. Indeed, the rates and the glitches could be linked—Avik Roy thinks the site has had traffic problems because it was designed to limit people’s ability to see the pre-subsidy price of insurance. If that’s true, even solving all the backend problems with the site won’t be enough to make the law popular in the long term. The GOP might still have an opening here, but it will have to act fast to seize it.

Published on October 15, 2013 1:47 pm
  • qet

    I completely disagree that, absent the shutdown theater, the Administration or the Democratic Party would suffer any meaningful consequences from the ACA’s implementation failures. The same MSM that carries the Administration’s water now would carry it under those circumstances. For every Republican that shouted “Scrap It!” or “Told You So!”, a thousand voices would shout “Fix It!” and “Why Do Republicans hate poor uninsured people?” No–aside from a few critical pieces like Klein’s (which would be held up as evidence of how neutral and fair the left is), the ACA’s failures would end up (and will end up) costing the Dems nothing in 2014 and beyond. Like Caesar, the only way to have prevented the monstrosity that the ACA is bound to turn into was to kill it in its shell.

  • rheddles

    In addition, the ACA’s effect on most people will be in the changes they see in their employer’s health care offering. Most Americans will not use ACA or ever visit the website. They aren’t directly affected by it. But they know their premiums are going up because of expansions in mandated coverage and their deductibles are going up because Bronze is the new standard. Making the ACA the focus will remind people who don’t use it that the reason their costs are going up is the ACA. You can bet that plenty of employers will blame increasing premiums and deductibles on ACA in open enrollment meetings.

    • cubanbob

      This thing can’t work no matter how much they work on the IT portion of it because at the underlying level it can’t work. Right now and for years I have been providing my employees a plan where I pay 100% of the employee HMO premium and the current plan with pre-ACA underwriting deductible of $2,500. When my plan comes up for renewal even if the premium stays the same if the deductible goes to $7,000 or more the plan is unaffordable for them even if I pay the HMO premium in full. And that’s for single employee deductible. This is why the employer mandate has been extended until after the 2014 election. The economics of this thing are impossible.

  • lehnne

    Remember Klein (and Mead) thought Obama was the guy to get it done; a gifted visionary, post-partisan,post-racial, the yes we can guy Eventually people will figure out the the political ruling class, both parties are populated by slackers protected by being unaccountable and opting out from the consequences of their ideological incompetence

  • Anthony

    The Avik Roy Forbes article referenced above provides additional context to ACA’s national launching.

  • http://foobarista.blogspot.com foobarista

    Shockingly, I agree with Klein on one thing: having worn a QA manager hat occasionally, I’d say that something that has this much major functionality as broken as it has deeper – and harder to find – bugs lurking underneath this functionality. Testing a big system is “onion-like”; as you find the surface bugs and get them fixed, deeper issues are revealed. As a QA manager, I knew we were getting close to release when new bugs were at the lowest level of the system, and were increasingly hard to find. A system with major nonfunctional areas in top-level stuff like authentication and user account handling would be many months (at least) from release.

    • BrianFrankie

      As someone who has also done some work in related areas, foobarista, I’m afraid I have to say that I believe you are actually underestimating the issues. Your description of the system testing is accurate if the basic system architecture is sound. In that case, you simply work through the bugs (preferably in beta testing rather than actual production) until the system is good enough. You are correct that this effort, when there are obvious and major bugs in the frontend is a months long effort.

      Unfortunately, the situation is worse for the federal exchanges. For the exchanges, the basic architecture is not correct. There are fundamental problems in the database relations and data calls. You could fix all the bugs and still not have a system that performs the functions it is supposed to. It will not be fixed in a few weeks. Or months. It will not ever be fixed. The desperation of the situation is compounded even further, if that is possible, by the fact that the bugs, errors, and architecture flaws are all interacting with the people supposed to use the system on a tight and rigid timeline – if things are not fixed by Dec, there is no point in the system’s existence, and the chances of things working in dec are zero. Megan McArdle describes some of the problems well:

      http://www.bloomberg.com/news/2013-10-14/obamacare-needs-a-drop-dead-date.html

      I see nothing for it other than the federal exchange will need to be completely scrapped and reengineered. It is possible I am wrong about this – I am hoping so – but I don’t see it.

      I find this is all extremely unfortunate, even distressing. I’ve never been a fan of Obamacare, and believe the law goes in precisely the wrong direction of the health care reform the US requires. But the exchanges were an exception to my opinion of the law. A good exchange, allowing consumer price transparency and other important market functions, would be a critical enabler for any health care reform. The fact that the federal exchange is mortally wounded and will need to be scrapped and restarted is going to considerably impair the timing and quality of the eventual health care reform the US will implement.

  • avery12

    Who shut down the government? Who is keeping it closed? Obama and Reid of course. With the media on their side, they write the story their way every day and every way.
    Now what could they have to gain from that? Everything.
    Until you are aware we have an unreliable narrator problem, you let Keyser Soze tell you the story without questioning or reading between the lines.

  • Boritz

    As you read the endless discussion of computer, cost, and administrative issues it’s important to remember that nobody has yet been reported to have died. Soon this same entity will manage the blood and pus of 300 million people.

    • Corlyss

      Yesterday John Batchelor reported on his show that in the first days in Washington state, the sign-ups for Obamacare consisted of 56% expanded Medicaid and only 10% for the qualified health plans. He finished up shouting, “They can’t pay for it! They can’t pay for it.” Here it is if you want hear for yourself; it’s the second segment of the hour:

      http://johnbatchelorshow.com/podcasts/2013/10/14/second-hour

    • dan

      What “same entity”? The federal government? “Manage”? It seems you expect death is a possibility from an online sign in. But that can’t be right. Boritz: please elaborate.

  • Corlyss

    Strong words maybe. But meaningless. There is no crack in the Progressive adoration for Dear Leader except as it perceives his failure to exceed the limits of their Utopian claptrap.