Dec 7, 2013
Don’t Give Up on the Uninsured
Posted on Oct 23, 2013
Obamacare is working.
True, that sentence comes with a large asterisk. It is working in states that have followed the essential design of the Affordable Care Act, particularly in Kentucky, Connecticut, Washington and California. The law was written with states’ rights and state responsibilities in mind. States that created their own health care exchanges—and especially those that did this while also expanding Medicaid coverage—are providing health insurance to tens of thousands of happy customers, in so many cases for the first time.
Those seeking a model for how the law is supposed to operate should look to Kentucky. Gov. Steve Beshear, a Democrat in a red state, has embraced with evangelical fervor the cause of covering 640,000 uninsured Kentuckians. Check out the website—yes, a website—www.governor.ky.gov/healthierky for regular updates on how things are going there.
“We’re signing up people at the rate of a thousand a day,” Beshear said in a telephone interview. “It just shows the pent-up demand that’s out there.”
Beshear urges us to keep our eyes on the interests of those the law is intended to serve, our uninsured fellow citizens. “These 640,000 people are not some set of aliens,” he says. “They’re our friends and neighbors ... some of them are members of our families.” As for the troubled national website, Beshear offered this: “If I could give unsolicited advice to the critics, and maybe to the media, it’s: Take a deep breath.”
Much is inexplicable about how the administration blew the launch. Everyone involved knew that this is President Obama’s signature achievement. Everyone knew that the repeal crowd would pounce on any difficulty, let alone a massive set of tech problems so easy to mock in an age when everyone has views as to what an online experience should be like. Everyone knew going in that this was a complicated endeavor. It is very hard to understand how the officials in charge could risk ignoring the red flags they apparently saw before the site went live.
Some explanations, however, are obvious. The federal government was not supposed to be running this many insurance exchanges. You might have expected that Republican governors who cherish the prerogatives of the states would, like Beshear, welcome the chance to prove that this free-market approach to providing insurance coverage could thrive.
Instead, bowing to tea-party obstructionism, most Republican governors took a powder. According to the Commonwealth Fund, only 16 states, plus the District of Columbia, have fully state-run marketplaces. Among the remaining 34 states, 19 are fully in the federally run marketplace, seven states have state-federal partnerships, and another seven are helping manage federally facilitated marketplaces. Utah is running a small-business marketplace, leaving individual plans to the feds.
Needless to say, the federal government wasn’t ready for this staggeringly complex task. Consider that individual states didn’t have to worry about any other jurisdiction’s insurance laws. The feds had to deal with sometimes vast state-to-state regulatory differences. I am told that an estimated 55 contractors and subcontractors had to collaborate on different aspect of the project. Reportedly, they all claim that their part of the enterprise works fine. It’s the interaction with the other pieces, they insist, that’s problematic.
Let’s imagine what a functioning political system would do now. First, we’d fix the site. Beshear and other governors are showing that the law can get the job done. Washington officials should look at the successful state exchanges and simplify the federal exchange as much as possible.
Second, Congress and the White House should use this breakdown as an opportunity to examine how the federal government acquires information technology. Are private contractors delivering what they’re paid for? Is the system biased in favor of certain big contractors with long-standing government relationships? The feds spend roughly $80 billion on IT systems. Are taxpayers getting their money’s worth?
But it would be unconscionable to give up on the goal of expanding the ranks of the insured simply because of tech failures. “They’re not going to walk away from this,” Beshear said of Obama administration officials, “and we’re not going to walk away from this.” Thus the spirit of a country that sticks with solving a problem, even when things get hard.
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