Obamacare Still Alive

By
Photo: Mark Wilson/2011 Getty Images

On Saturday, the Obama administration announced that it had mostly fixed healthcare.gov, and how you choose to interpret that is largely a matter of spin. The administration has a report detailing all the good things about “mostly fixed”: page error rates are down from 6 percent to about 0.75 percent, the system is now operating 90 percent of the time, up from 42 percent of the time, it can handle 50,000 users at a time now, and so on. On the other hand, a system that’s mostly fixed is still partly broken. You can read gop.com, or similar takes from conservative sources like the Wall Street Journal editorial page or Reason magazine, for a summary of all the ways the website is still less than optimal or could go wrong in the future. While the tone of the competing spins radically differ, the underlying facts are essentially identical. It’s like reading competing weather forecasts: Mostly sunny! No, partly cloudy!

Where does Obamacare stand now? A few things have become clear:

The website is running in the right direction. The pessimistic takes don’t really deny that the site is better, or that it can become still. The fact that some states that built their own exchanges (like Kentucky) are enjoying a smooth enrollment process shows pretty clearly that the model is fundamentally workable.

It will still be a huge mess. The administration has focused its efforts on fixing the user experience of the website. The backend remains a major mess for insurance companies. The site is frequently feeding them wrong information about what consumers signed up for, what tax credits they’re eligible to receive, and so on. This report from Robert Pear and Reed Abelson suggests that January, when the program begins, is likely to be chaotic. The kinds of disarray we’ll experience are hardly unfamiliar — have you ever had an insurance company that screws up your paperwork for week after infuriating week? I have — but will be unusually widespread. Still, this will eventually be fixed, too.

The administration is projecting competence. The response to the healthcare.gov debacle is intended to address not only the proximate failure of the website but also the secondary, equally large problem that the Obama administration appeared inept. The meta message of the administration’s website-fix rollout this weekend was “we know what we’re doing.” Its report was filled with crisp metrics modeled after well-functioning tech companies. It opened up its fix team to a long-reported take from the New York Times, which displayed an administration that followed the bureaucratic ineptitude of the website first with shock but then a well-organized response led by the highly regarded Jeffrey Zients.

There is no existential threat to Obamacare. The failure of the website rollout raised the possibility that the law itself might unravel. Conservatives still believe that will happen. But, then, they thought it would happen even before the website rollout, because they think Ayn Rand novels are an accurate gauge of how government programs generally function. (Scratch an Obamacare-doom column and eventually the Rand references will bleed out.) If, like me, you didn’t expect the law to collapse on itself, you probably don’t think that now.

The main questions at hand are how well it will muddle through. The dreaded “death spiral,” in which insurance markets are overloaded with sick, expensive customers, is highly unlikely to materialize, for several reasons: Both insurers and the administration have extensive plans to reach out to younger customers; the enrollment period lasts through the end of March, and people tend to enroll at the last minute; the law has a crucial financial backstop to protect insurers in case they get stuck with disproportionately sick customers to begin with.

Democrats will not repeal Obamacare. Even in their most panicked moments, only a handful of Democrats in the House voted for the Upton bill, which would have kept unregulated individual market plans that skim off healthy customers operating in perpetuity. The only way to repeal or cripple the law before 2017 is to muster a veto-proof majority in both chambers of Congress, a conservative fantasy that would require the support of huge numbers of liberals in Congress.

So what are we fighting about? How smoothly the law operates, and how many customers it manages to enroll by the end of Obama’s term, are open questions. Likewise up for debate is whether Obama’s approval ratings will recover. But these are not fundamentally questions about the life or death of Obamacare. They’re about how much political pain Democrats in Congress must endure. We’re not fighting over health-care policy. We’re fighting about the midterm elections.