I read a fair amount of ACA news, but I really have no idea the answer to one question: To what extent should the various mostly minor delays and glitches -- such as this one -- be attributed to:
1. Poor execution (and if so, is the the WH? Specific agencies? The states?);
2. Poor construction of the legislation to begin with (and if so, who specifically was responsible?);
3. Implementation underfunding insisted on by House Republicans;
4. Other GOP obstruction;
5. Just general "things happen" when you try to launch large, complex programs.
Or, of course, something else I'm not thinking of.
I realize that the most urgent need for reporting is on what exactly these glitches are and how they will matter, but I do hope we eventually get some good digging into what was responsible for those things didn't go right -- and, while they're at it, why some things did go smoothly.
And in the meantime, I'd love to see some informed speculation about how important each of these five (or more) factors have been. Here, for example, is (anti-ACA) Philip Klein opting for door #2; pro-ACA Jonathan Cohn, however, seems to be thinking door #5. What about it, ACA rollout reporters and close observers?
Thursday, September 26, 2013
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#4 is a big deal. State-level obstruction should be its own category, frankly. Wisconsin is actually using the occasion of the Obamacare launch to kick people off Medicaid and into the exchanges, making it more complicated and onerous than it needs to be. Plus, to the extent that they are trying to implement it at all, they are focusing way, way more on fraud prevention than is actually called for by any objective measure of the incidence of fraud.
ReplyDeleteAnother small thing about implementation: while the website to sign up is easy to remember (healthcare.gov) the hotline is a random seven digits, instead of something simple like 1-800-HEALTHY or 1-800-COVER-ME.
The so-called "family glitch", however impactful it ends up being in practice, is undeniably #2, and thus might generally tilt the conclusion toward #2, pending of course how big a problem the family glitch ends up being.
ReplyDeleteI'd make the same argument about the too-small (and now temporarily non-existent) employer penalty, but I'm sure no one in this audience wants to hear that again.
On the other hand, the fact that the family glitch hasn't been fixed already, and won't be, brings us back to #4.
DeleteYeah, wouldn't be surprised if a lot of problems that turn up are #2 issues not being fixed because of #4.
DeleteLike that thing with churches having problems with the exchanges because of oversights. That's definitely #2, but Republicans (per #4) don't want to fix it.
All of the above, but specifically #1 and #5. "High error rate" in dealing with premium tax rates is what is being cited as the hangup. This comes as a result of various factors (not the least of which being this bill being rushed through to avoid senseless GOP obstruction - that is, ignoring reality), but it's mostly a result of a huge program having early implementation difficulties.
ReplyDeleteReally, the origin of the blame for all of this can be laid squarely at the feet of big insurance - a topic I discuss here:
http://www.smartlivingnetwork.com/viewpoint/b/The-Affordable-Care-Act-Brought-To-You-By-Big-Insurance/
Honestly I have a feeling that if the press examines what was responsible for these glitches, it'll be even more polarized than general information of the ACA.
ReplyDeleteThis is one example of how conservative opposition to the ACA is backfiring. Even if they're right and the law ends up with tons of problems, they've made it so that it's very easy for Democrats to blame them for it.
As I understand it, a majority of states have refused to participate in creating the health insurance exchanges. I think that the feds really expected much more in the way of cooperation from the states on this front. And yes, most of the states that refuse to participate are Republican dominated ones.
ReplyDeleteSee here: http://kff.org/health-reform/state-indicator/health-insurance-exchanges/
I can't help but think that the total lack of cooperation from the states has created a lot more work for the feds to get this thing implemented.
From what I understand, the option to have the Federal Government run an exchange for a state wasn't even really something they expected to have to do. They assumed pretty much all the states would set up exchanges, but they left the option for the Federal Government to do it in case something went wrong.
DeleteThey didn't realize that so many states would require Federal Exchanges. That huge workload with building the Federal Exchanges was basically unexpected.
The Feds also never expected the Supreme Court to say that states could reject the Medicaid expansion.
Just out of curiosity, what is the "family glitch"?
ReplyDeleteSee the article that CSH linked to.
DeleteI'd use a variant of #5: The 2014 timeline was very aggressive, under normal circumstances. A ton of regulations had to be written, programs had to be implemented across 50 states, and the degree of difficulty was high. Even before considering the close to unprecedented obstruction problems across the board, I think you've got your question wrong. I'd say, "How did so much get done so quickly?"
ReplyDeleteI'm not sure how much any of this matters. Most people in the US get their healthcare from their employers or they are on Medicare. I guess there are some who are privately insured, but I'm guessing that the insurance companies are not going to kick them out of a plan they already have. So these glitches will really only affect those who don't currently have insurance. Now maybe some of those who don't currently have insurance will be super eager to get insurance, but will have no tolerance for glitches, but my guess is that come January 1, most currently insured people will see their regular doctor, have it paid by their regular insurer and wonder what ever happened to Obamacare?
ReplyDeleteAs a veteran of many corporate IT implementations, I have to say that nearly 100% of large system projects experience delays, and most fail utterly to provide the benefits used to justify them.
ReplyDeleteThese projects are a) very, very difficult technically and b) require many changes in behaviors and attitudes by stakeholders.
I don't have any first-hand data, but I have to believe that the squeeze on implementation funding by the Republicans has made things much worse. I read one blog post (can't find the link) that discussed a team that was supposed to have 5 people trying to complete their task with only 2. That's tough if it is at all common.
This might fall under #5, but I'd be tempted to add "#6: the software economy." I'm not sure how much America outside tech hubs feels this, but we're in the middle of a white-hot software market right now. It's _really_ hard to hire good engineers.
ReplyDelete