Time Running Out for Obamacare Fixes

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Shawn Thew / EPA

President Barack Obama responds to a question from the news media during a press conference in the briefing room of the White House in Washington, Oct. 8, 2013

They have one month. If the officials running the new Affordable Care Act insurance exchanges cannot fix crippling computer glitches by then, the health law’s future could be imperiled, according to a former high-ranking health care official.

“By November—certainly the middle of November—the sites have to be able to handle major traffic for people to be able to set up accounts and purchase coverage,” says Joel Ario, who served as director of the Office of Health Insurance Exchanges at the U.S. Department of Health & Human Services (HHS) from August 2010 to September 2011.

Since the Oct. 1 launch of state-based insurance web sites where uninsured Americans can shop for new health coverage, the exchanges have been riddled with computer problems causing crashes and error messages. Administrators for both state-run exchanges and those being managed by the federal government have brushed off concerns that the glitches mean the health care law is fundamentally flawed. They point out that the open enrollment period that began this month lasts until March 31, 2014, and the earliest new coverage can begin is Jan. 1, 2014.

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But the longer it takes to repair problems with exchange web sites, the harder it may be to enroll Americans who want coverage. The Obama Administration and states have blamed early web site problems on overwhelming interest in the exchanges, saying the sites couldn’t handle the heavy traffic. But that interest that will only increase as a Dec. 15, 2013 deadline for purchasing a plan that starts Jan. 1 approaches.

“The more truncated that period is, the higher volume will be,” Ario says.

The most pressing problem for the Obama Administration is adding capacity and fixing bugs in healthcare.gov, the web site managing insurance enrollment for more than 30 states. Visitors to the site have endured long wait times, error messages and glitches impeding registration, which is necessary to see available insurance plans and prices. Some state exchange web sites, like Kentucky’s, that allow visitors to browse plans without establishing identity-specific accounts appear to have been better equipped to handle heavy traffic at this early stage.

“We did have the same sorts of issues on Tuesday [Oct. 1], but we were able to get them fixed faster,” says Gwenda Bond, a spokesperson for the Kentucky cabinet for health and family services, which oversees the state’s exchange. As of Monday, 1,527 Kentucky individuals and families had enrolled in new health plans, more than in most other states. Maryland’s health exchange, which has experienced major glitches, said just 326 people had enrolled as of Oct. 1. (The federal government and some states have so far declined to provide enrollment figures.)

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Ario cautions against condemning the health care exchanges based on early enrollment data, however, pointing out that few Americans may want to sign up and pay for coverage that doesn’t begin for three more months. Right now, he says, “The vast majority of people want to look at options and basically browse.” Enrollment en masse may not begin for weeks.

Aside from the risk that fewer people will get health coverage if web sites are not repaired soon, another long-term concern raised by the computer problems is the composition of the insurance pool. Says Ario, “The people who most need coverage will get it. They’ll be patient and they’ll work through the glitches. The people who don’t need it now will be less patient. The easier the enrollment, the better the chances of having a balanced insurance pool.”

Balancing the pool so that risk is spread among a diverse population, which will keep prices in check, depends on exchanges attracting young and healthy Americans who are typically cheap to insure. These people, who are not in need of major medical care right now, may give up on glitch-prone exchange web sites. Imagine a 20-something chided by his parents to get health coverage he might not think he needs and encountering error messages and delays signing up. This scenario, according to Ario, could go something like this. “Gee, Mom, I really tried and I waited on that site for an hour, but I couldn’t do it.”

If the coverage plans sold through the Obamacare exchanges are stacked with sicker and older Americans, insurers will have to raise prices for 2015 plans. If people balk at those premiums, the exchange system itself could be in danger.

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