I can't believe I'm writing this sentence, but Obamacare's exchanges appear to somehow be more deeply corrupted and broken than previously known. If there were words more impactful than "meltdown" and "trainwreck," I'd use them. Instead, I'll simply present the facts as they continue to come to light. USA Today:
The federal health care exchange was built using 10-year-old technology that may require constant fixes and updates for the next six months and the eventual overhaul of the entire system, technology experts told USA TODAY....Recent changes have made the exchanges easier to use, but they still require clearing the computer's cache several times, stopping a pop-up blocker, talking to people via Web chat who suggest waiting until the server is not busy, opening links in new windows and clicking on every available possibility on a page in the hopes of not receiving an error message. With those changes, it took one hour to navigate the HealthCare.gov enrollment process Wednesday. Those steps shouldn't be necessary, experts said..."The application could be fundamentally flawed," said Jeff Kim, president of CDNetworks, a content-delivery network. "They may be using 1990s technology in 2.0 world." Outsiders acknowledged they can't see the whole system, but they said they feared HHS built a system that will need an expensive overhaul that would cause more headaches for people trying to buy insurance.
There was no progress for the new federal health insurance exchange's information technology and enrollment challenges in its second week. At the end of week two of the Obamacare launch, health plans were generally seeing no more enrollments per day then they saw in the first week. As troubling, the backroom issues plaguing the connection between health insurers and the federal government had not been resolved and there is no indication from the feds when they will have these things cleared up. My sense is that the feds, based upon the number of enrollments they have sent to the insurance companies, enrolled about 10,000 people in the first week (about 5,000 single and family contracts) and another 10,000 people in the second week in the 36 states using the federal exchange...Most states running their own exchanges aren't doing a whole lot better.
One of those states is Maryland. I noted at Hot Air this week that Maryland's strongly pro-Obamacare governor was forced to admit that his state's exchange likely won't be functioning for at least another 4-6 weeks. Mary Katharine Ham followed up on this point, explaining why Maryland's big whiff should be profoundly worrying to the Obama administration:
This is the state that’s a perennial leader in the number of health care mandates it places on businesses and consumers, and has the army of health regulatory bodies to match. Even when the administration delayed important rules to prevent them becoming election fodder, Maryland forged ahead without. Formed by state legislation in early 2011, the Maryland Health Benefit Exchange Board met at least once a month starting in June 2011 to plan the build. The board, ironically, has a thorough and functioning website of its own. A calendar of events lists more than 200 meetings of exchange officials, working, business, and community groups about the exchanges over the last two years...Jonathan Cohn, a health care reporter at The New Republic and an Obamacare supporter, declared in 2011, “none are moving as quickly, or effectively, to follow through on the law as Maryland Governor Martin O’Malley.” ... If there was ever a state that was, in good faith, trying hard to get an exchange operational, Maryland was it. And, yet, Maryland produced a disaster that may not be fixed in time to prevent the “death spiral.”
Be sure to read the entire piece for bonus comments from both Obama and O'Malley, prematurely congratulating themselves on Obamacare -- which they've argued is a testament to the virtues of expansive government. Oops. Meanwhile, the "death spiral" concept is really important to this entire discussion. Megan McArdle explains it well in her indispensable Bloomberg piece, but the idea is straightforward: Because the exchanges are so dysfunctional, only the most motivated consumers are likely to tough it out and work really hard to enroll. These people, for obvious reasons, tend to be sicker, older folks with pre-existing conditions. So if they flood into the market --while young and healthy people do not (thus off-setting the others) -- insurance companies will have no choice but to jack up rates on everyone to compensate for their new, unusually costly, enrollees. This, in turn, will drive younger, healthier consumers to exit the market, making the problem worse. Unless Obamacare gets its act together very soon, and manages to get millions of "young invincibles" to voluntarily overpay for coverage (rather than pay the cheap penalty tax), the entire insurance market breaks down. As Laszewski's analysis demonstrates, the sign-up rate is pathetically low -- so much so that HHS is now denying that they ever had monthly enrollment goals in the first place. Yuval Levin, a conservative healthcare wonk, has written a lengthy and important piece at National Review, based on numerous discussions with Obamacare and insurance officials. Behind the scenes, chaos and "restrained panic" reigns:
If the problems now plaguing the system are not resolved by mid-November and the flow of enrollments at that point looks like it does now, the prospects for the first year of the exchanges will be in very grave jeopardy. Some large advertising and outreach campaigns are also geared to that crucial six-week period around Thanksgiving and Christmas, so if the sites are not functional, all of that might not happen—or else might be wasted. If that’s what the late fall looks like, the administration might need to consider what one of the people I spoke with described as “unthinkable options” regarding the first year of the exchanges...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..And they believe, as the CMS officials I spoke with do, that all of these problems will not be addressed immediately. No one wants to say how long it might take, and no one would share with me what estimates they might be getting from their contractors (whom they no longer trust anyway), but there has so far been relatively little progress and it seems like everyone involved is preparing for a process that will take months, not weeks.
Levin's sources (all Obamacare supporters, by the way) say that, paradoxically, the tiny trickle of enrollees is actually something of a blessing in disguise. Why? The back-end connectivity issues are so terrible, that an avalanche of "successful" sign-ups could cripple that part of the system. "Trainwreck" doesn't even suffice. And all this, despite three-and-a-half years of lead time (most of which the administration frittered away for political reasons), and a mammoth tech budget -- which tripled, and still resulted in failure. How the hell is Kathleen Sebelius' job secure? Finally, on the subject of rank political concerns, a new Politico report is as jaw-dropping as anything else mentioned in this post:
Facing such intense opposition from congressional Republicans, the administration was in a bunker mentality as it built the enrollment system, one former administration official said. Officials feared that if they called on outsiders to help with the technical details of how to run a commerce website, those companies could be subpoenaed by Hill Republicans, the former aide said. So the task fell to trusted campaign tech experts.
Having already punted reams of key regulations past the election -- making the timeline for a relatively seamless launch all but impossible -- the administration decided against seeking certain outside expert assistance to develop Obamacare's exchanges because...they were afraid that Republicans might find out how badly things were going. So they kept it all in-house, hush-hush, beyond the reach of GOP investigators, and, you know, the public -- a large portion of which would be relying on these sites for their healthcare. Allahpundit encapsulates things well: "Between this and the fact that HHS deliberately hid the price of insurance behind a reg wall on Healthcare.gov to reduce 'rate shock,' the grand takeaway about the website’s failure is that O and his team made it much worse than it needed to be because they were terrified of transparency. And the reason they were terrified of transparency...is because they know they’ve delivered a bad product." This crosses the line from gross, mind-blowing incompetence to corrupt, myopic malpractice. I'll leave you with Alan Colmes (!) calling for a one-year delay of the whole enchillada. Bear in mind that this segment aired before any of the above information became public:
Sure, they've royally screwed up the entire website beyond all comprehension via a combination of ineptitude, arrogance and corruption -- but the program itself will be great! Good luck with that argument. Tick tock, Mr. President. Were Republicans right about delaying the big government mess you've created? Or are you going to forge ahead to save face, harming millions of people in the process?
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