The Obamacare debate: the good, the bad — and the political

http://www.theguardian.com/world/2013/oct/23/obamacare-debate-the-good-the-bad-and-the-political

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For the millions of Americans whose health insurance falls short of their health risks, the success or failure of the Affordable Care Act will divide itself over a simple line of needs met and unmet. If the law moves needs across the line to the "met" side, it works. If the needs herd in the other direction, it doesn't. The stakes are not an election. The stakes are what happens after a cancer diagnosis or a car accident or a premature birth.

Even for people who currently enjoy secure health insurance, the question of whether Obamacare works does not sit entirely at a nice theoretical remove. If problems with healthcare.gov are not fixed, disruption to the insurance industry could make existing coverage more expensive or less good. The resulting tax burden and political turmoil could be bad for everyone.

More than three weeks after the launch of the health exchanges, Congress has scheduled the first – of what are sure to be many – investigative hearings for Thursday. Contractors who built the site are to testify before the House energy and commerce committee about what went wrong and who knew about it, when.

At this innocent moment, before the Capitol Hill carnival begins, a scan of the conversation over the turbulent rollout of Obamacare is in order. The conversation falls into five categories. There are consumer success stories; consumer horror stories; site mechanics stories; blame game stories; and, yes, politics stories. Here's a look at some highlights:

Consumer success stories

'I was an Obamacare guinea pig' – Sally Kohn, FoxNews.com

There were literally 50 plans that were better than my current insurance – both with lower premiums, lower out-of-pocket costs and better coverage. And there were ten plans with a higher premium than my current insurance, but with lower deductibles.

'Percentage of Americans lacking health coverage falls again' – Robert Pear, the New York Times

One of the most popular provisions of the 2010 health care law allows young adults to stay on their parents’ insurance policies until age 26. That provision appears to be having its intended effect.

Among people ages 19 to 25, the proportion who were uninsured declined to 27.2% in 2012. Though the bureau said that figure was not significantly different from the 2011 rate, it was down from 29.8% two years earlier.

Consumer horror stories

Look no further than 'Your Story,' a website established by House Republicans to collect tales of the gnarliest healthcare.gov disasters.

'Thousands of consumers get insurance cancellation notices due to health law changes' – Anna Gorman and Julie Appleby, Kaiser Health News

This one made it to the top of the Drudge Report:

Health plans are sending hundreds of thousands of cancellation letters to people who buy their own coverage, frustrating some consumers who want to keep what they have and forcing others to buy more costly policies. [...]

By all accounts, the new policies will offer consumers better coverage, in some cases, for comparable cost – especially after the inclusion of federal subsidies for those who qualify. [...]

But the cancellation notices, which began arriving in August, have shocked many consumers in light of President Barack Obama’s promise that people could keep their plans if they liked them.

The site mechanics are flawed

'Healthcare.gov: it could be worse' – Rusty Foster, the New Yorker

Picture the dashboard of your car, which has a few knobs and buttons, some switches, and a big wheel – simple controls for a lot of complex machinery under the hood. All of these systems, whether in your car or on Healthcare.gov, have to communicate the right information at the right time for any of it to work properly. In the case of Healthcare.gov, we don’t know what precisely has gone wrong, because the system isn’t open-source – meaning the code used to build it isn’t available for anyone to see – and nobody involved has released technical information. But the multiple databases and subsystems are probably distributed all over the country, written in a variety of computer languages, and handle data in very different ways. Some are brand new, others are old. [...]

But it’s starting to work. It will be fixed, because it has to be. And now that the launch and inevitable crash has finally happened, in a way the worst is over.

'Programmers saw red flags while building Obamacare website' – Jack Gillum and Julie Pace, the Associated Press

A review of internal architectural diagrams obtained by the AP revealed the system's complexity. Insurance applicants have a host of personal information verified, including income and immigration status. The system connects to other federal computer networks, including ones at the Social Security Administration, IRS, Veterans Administration, Office of Personnel Management and the Peace Corps.

The administration acknowledged that a planned upgrade to the website had been postponed indefinitely and that online Spanish-language signups would remain unavailable, despite a promise to Hispanic groups that the capability would start this week. And the government tweaked the website's home page so visitors can now view phone numbers to apply the old-fashioned way or window-shop for insurance rates without registering first.

‘Obamacare is a bit like the astronaut on top of the rocket’ – Bob Laszewski as interviewed by Ezra Klein, the Washington Post

The insurance industry is literally receiving a handful of new enrollments from the 36 Obama administration-run exchanges. It’s really 20 or 30 or 40 each day through last week. And a good share of those enrollments are problematic. One insurance company told me, “we got an enrollment from John Doe. Then five minutes later we got a message from CMS disenrolling him. Then we got another message re-enrolling him.” On and on, up to 10 times. So insurers aren’t really sure if the enrollments they’ve got are enrollments they should have.

'Assessing the exchanges' – Yuval Levin, the National Review

The tone of the CMS officials who spoke with me was a kind of restrained panic. Among the insurance company officials (who, I should stress again, work in the Washington offices of some large insurers, and so are basically policy people and lobbyists), there was much less restraint. The insurers are very, very worried about the viability of the exchange system—especially but not exclusively at the federal level.

The blame game

'Sebelius thrust into firestorm on exchanges' – Sheryl Gay Stolberg, the New York Times

“We’ve got lots of questions,” said Representative Joe Pitts, Republican of Pennsylvania and chairman of the panel’s health subcommittee. “Why would she mislead us so shortly before the rollout, when they were obviously not prepared and are still not prepared, and it’s going to take a long time to fix the problem? We want to know how long she thinks it is going to take.”

'Sebelius: Obama didn’t know about website problems beforehand' – Jonathan Easley, The Hill

Speaking on CNN’s AC360, Sebelius was pressed on when the president learned about the technical issues surrounding the Obamacare website. The Health and Human Services secretary said it “became clear" to the president "in the first couple of days,” but that Obama didn't know about the problems until after the Oct 1 rollout.

Blame the other side

'Liberal pundit fail: rush to attack Obamacare site only aids unhinged right' – Joan Walsh, Salon

Don’t get me wrong: The problems with Healthcare.gov are real, and disturbing, and must be fixed asap. (Think Progress has a dispassionate assessment here.) But excuse me if I believe the president knows that without my telling him. It’s like watching the 21st century version of the rise of the Democratic Leadership Council, and I feel the way I did back then: On the one hand, yes, it’s important for Democrats to acknowledge when government screws up, and to fix it.

On the other hand, when liberals rush conscientiously to do that, they only encourage the completely unbalanced and unhinged coverage of whatever the problem may be.

'Take this, conservatives: criticism only makes Obamacare stronger!' – Brian Beutler, Salon

Let’s stipulate that the conservatives crying crocodile tears for uninsured Americans who’ve been badly inconvenienced by broken Obamacare websites are engaged in a world-historical performance of organized concern trolling. If you’re a reporter or a news junkie or a constituent, you should be absolutely clear that these people don’t want Healthcare.gov to work and are making wild, unsupportable claims to discourage people from becoming insured.

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