National Review Online
Tuesday, October 22, 2013
The rolling fiasco that is the launch of the
health-insurance “exchanges” — the government-run online marketplaces at the
heart of the Affordable Care Act — is something the Obama administration is
attempting to explain away as a “glitch,” but it now threatens to throw an
entire AutoZone worth of wrenches into the Rube Goldberg machine that is
Obamacare. Health and Human Services managers close to the project privately
say that hitting early enrollment goals will be all but impossible. The White
House has called the situation “unacceptable” (yet it is accepted); insurance
companies attempting to use the system are in a state of panic; only a handful
of states have their own working exchanges; and the federal exchange is snarled
up in Washington’s usual managerial incompetence. Nobody knows how long it will
take to fix the problems, or whether they even can be fixed. The president has
said that there is “no excuse” for this mess, but there is no one taking
responsibility either, nor any credible timetable for getting it sorted out.
In retrospect, those Republicans who sought a delay of
Obamacare’s implementation would have been doing the Obama administration — to
say nothing of the country — a favor had they been successful.
The problem is not only crash-prone servers that make
signing up for the exchanges a Sisyphean task. A larger problem is that they
are running on faulty data. The exchanges are there to facilitate transactions
involving consumers, the federal government, and insurance companies, but
information is not reliably transmitted among the three. For example, faulty
programming has led to miscalculations of subsidies that consumers are to
receive under the program, which means that a great many of them will get
premium bills that are far different from what they expect. (Far higher or far
lower? Bet on the former.) Insurers are not receiving enough accurate
information to process applications from consumers. As of October 19, not one
person in New York State had been able to complete a purchase through that
state’s exchange. Consumers are not getting accurate information about the
plans that are available to them.
The deeper problem for Obamacare is that in order for the
new ACA-compliant insurance plans to succeed, a very large number of healthy
young people need to enroll — paying much higher premiums than they would have
paid before Obamacare — in order to offset the costs incurred by extending
subsidies and coverage to the old and the sick. If the insurance plans offered
under Obamacare attract too many old and sick people and too few young and
healthy people, they will not be financially viable. But young and healthy
people do not have much incentive to comply with the ACA in the first place,
and the catastrophically dysfunctional enrollment process has given them a very
strong incentive to wait it out.
Uninsured Americans subject to Obamacare’s individual
mandate are required by law to sign up for new policies by February 15 or face
a fine. Those seeking new policies beginning in January of the coming year must
sign up by December 15. It is unlikely that the defects in the system will be
repaired by December or by February.
And those are just the computer-system problems. The
deeper problems with the bill will not be repaired by December or February or
by two summers hence, because the administration is not interested in repairing
them. Obamacare will leave many Americans paying premiums that are twice as
high — or more than twice as high — as those they paid before, and facing prosecution
if they do not buy those more expensive plans. This is being done in the name
of improving the market for insurance, while in fact converting insurance from
a hedge against disaster into a universal system of prepaid health care at a
substantially higher cost than the old one.
One of the reasons for that higher cost is that the new
program is just a front for the old program: Medicaid, an expensive and
dysfunctional mess of an entitlement. In Oregon, the 56,000 people who enrolled
in health-care coverage under the new law in the first two weeks of October
went exclusively into Medicaid — not one person was enrolled in a private
insurance plan. Illinois has sent more than 100,000 into Medicaid under the
program. Medicaid’s perverse incentive structure has ensured explosive growth
in its spending over the years, while, more perverse still, its attempts to
reduce costs by restricting providers’ payments to below-market levels means
that few Medicaid recipients actually have access to care — and fewer still to
very good care.
Republicans may have failed thus far in their efforts to
repeal Obamacare, but the administration is in the midst of a much more
significant failure: a failure to execute its own vision with a minimum degree
of competence. The president can blame software developers and vendors all he
likes, but this is his mess, and if he can’t clean it up — and he can’t — then
it is up to Congress to do it for him. Repealing and replacing Obamacare
remains a live issue, and Republicans would do well to pursue it.
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