The Affordable Care Act — Obamacare — was never my idea of the perfect health care reform package, but after it passed into law, I got on board because it offered the opportunity to put a brake on the trajectory of decreasing access to increasingly expensive health care and health insurance. I’ve written and spoken extensively in support of various features of the ACA including the insurance market reforms and the value of the health insurance exchanges. Skeptical at first, I came to appreciate the importance of the individual mandate to the entire package. In fact, I’m now much less enamored of the employer mandate. I find myself citing the Heritage Foundation’s 1989 paper advocating for an individual mandate and against an employer mandate.
But now I’m upset. It’s not that the exchange rollout wasn’t smooth. It’s a huge, complicated project that was almost certain to have problems. Look at what happened in 2005 when Medicare Part D rolled out: the website didn’t work; the call center had long waits and dropped calls. What bothers me about the exchange rollout is that there was no warning, no indication that on October 1, the site wouldn’t work like a charm. In the first few days, as people struggled to log on and establish accounts, we were told heavy utilization was the problem. Now it’s clear that there are design flaws that need significant attention, and that at least some of this was known at the Department of Health and Human Services.
Those who advocated for the exchanges and especially the community-based organizations that are devoting significant resources to getting people enrolled in exchange plans have been left flat-footed. They can’t do their work as intended, which is hard enough anyway. If they’d known there would be problems, they could have revised their work plans accordingly. They would have been better able to set the public’s expectations about the enrollment process.
Why weren’t we aware of all of this? Politicians of all stripes have all sorts of explanations. I certainly don’t know the reason, but it seems to me that softening expectations in advance of October 1, and reminding people of President George W. Bush’s Medicare Part D rollout problems, would have been prudent. I still believe in the enormous value the exchange plans have to offer Americans. And I know that the ACA is more than a website. And I think they’ll get it fixed. But I’m deeply disappointed at being left in the dark.
Elena M. Marks is the Baker Institute Scholar in Health Policy and the chair of the board of directors of Community Health Choice, a nonprofit organization serving more than 200,000 members. She is an attorney with a master’s degree in public health and currently works as a consultant to the health care industry. From 2004 through 2009, Marks served as the director of health and environmental policy for the City of Houston.
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