ACA on the clock: How long does the administration have to clean up its mess?

January 12th, 2015

Whatever distraction the partial government shutdown created from all the problems attendant to the launch of healthcare.gov, it’s over now. Indeed, the health insurance marketplace is the latest battleground in the continuing political struggle over the Affordable Care Act.

On Monday, the president acknowledged there have been serious problems with the website, an admission that appeased essentially none of his opponents, some of whom are urging the resignation of HHS Secretary Kathleen Sebelius as well as the rolling of various other heads in the government. The circus officially comes to town tomorrow morning, with a Congressional hearing called “PPACA Implementation Failures: Didn’t Know or Didn’t Disclose?”

The stakes of all this are real. Right now, there are 159 days left before open enrollment ends (the deadline is December 15 for coverage that would start Jan. 1, 2014), and plenty of experts are telling various media outlets that the problems had better be fixed well before then or the entire program will be in trouble. After all, the government has said it’s hoping for 7 million enrollees the first year, and problems signing people up now could have long-term consequences.

According to a really good article about this from Julie Appleby at Kaiser Health News, “The risk in frustrating consumers is that those who are healthy or on the fence about enrolling may give up, leaving the unhealthy to persevere and enroll, which could drive up premiums in future years, potentially leading to what experts call ‘a death spiral,’ where only the sickest people sign on.”

And just telling young, healthy people to use the phone or snail mail isn’t likely to do much good. They want to sign up online, and if the website’s too much of a hassle for them to deal with, it could be a struggle to recapture their interest.

Maybe Jeff Zients can make a difference in resolving healthcare.gov’s problems soon, but some in the tech world are skeptical of any sort of quick fix, given the complexity of the site and the volume of traffic it has to contend with.

My favorite quote about this is from Tom Scully, a former administrator of CMS. According to an NBC News article:

“Although much criticism has focused on a Canadian firm, CGI Group, that did some of the work for the federal government, Scully says the administration probably should have contracted out even more of the work. CMS was never equipped to do the work in-house, he says.

“'They are just slow-moving, bureaucratic, lovely people,’ Scully said.”

Or, as we say in the South, “Bless their hearts.”

So anyway, it’s a mess, and it looks as though we won’t find out until at least early November just how big of a mess. That’s probably the earliest the administration will release actual enrollment figures. If the number’s lower than expected, we might start hearing calls to push back the deadline for open enrollment, a move that could open a whole new can of worms.