Why the
exchanges are worse than even the critics imagined.
The Wall
Street Journal
Updated
Oct. 17, 2013 8:59 p.m. ET
The White
House set low expectations for the Affordable Care Act's October 1 debut, so
anything remotely competent should have seemed like a success. But three weeks
on, the catastrophe that is Healthcare.gov and the 36 insurance exchanges run
by the federal government is an insult to the "glitches" President
Obama said were inevitable.
This isn't
some coding error, or even the Health and Human Service Department's usual
incompetence. The failures that have all but disabled ObamaCare are the result
of deliberate political choices, which HHS and the White House are compounding
with secrecy and stonewalling.
The health
industry and low-level Administration officials warned that the exchanges were
badly off schedule and not stress-tested despite three years to prepare and
more than a half-billion dollars in funding. HHS Secretary Kathleen Sebelius
and her planners swore they'd be ready while impugning critics and even
withholding documents from the HHS inspector general for a routine performance
audit this summer.
Yet the
launch has been worse even than critics predicted. The rare users who weren't
locked out experienced crashes, delays and error messages. Mrs. Sebelius
initially claimed this was merely servers crashing under unexpectedly high
demand. She called it "a great problem to have."
Health and
Human Services Secretary Kathleen Sebelius Associated Press
Now that
traffic has abated, HHS concedes there were built-in information technology and
structural defects. Some of Healthcare.gov's automatic operations mimic hacker
denial-of-service attacks meant to disable a site. These can be fixed, though
press reports suggest they're due to a programming rush because HHS delayed key
regulations and IT specifications until after the election to avoid Republican
criticism.
Then
instead of rolling out the program in stages or delaying it as HHS has so many
other parts of the law, the department simply dumped a bad product on the
public to meet a self-created deadline.
Other
failures have the same political character. Consumers must set up a complex
account with sensitive personal information like Social Security numbers before
they are allowed to browse health plans. The government wants to show consumers
only their net out-of-pocket premiums minus subsidies, not the true underlying
cost of insurance. That's because those all-in quotes are so much higher than
what's available on the individual market.
HHS
continues to claim that the exchanges are all about competition—they're even
trying to rebrand them as "marketplaces." But real marketplaces are
transparent and let consumers know what they get for what price. ObamaCare's
exchanges are intended to obscure price and service options.
HHS still
refuses to disclose how much taxpayers shelled out for this exchange lemon. The
money came from several ObamaCare, general HHS and Medicare accounts and flowed
to more than 50 outside vendors, with several no-bid contracts awarded outside
the normal procurement process.
Mrs.
Sebelius also refuses to reveal basic data about ObamaCare enrollment even as
she brags about the millions of people who have supposedly visited
Healthcare.gov. Information that would allow outsiders to evaluate the
exchanges includes how many people have applied and qualified for coverage so
far, what types of health plans they're selecting and what their health risks
are.
Mrs.
Sebelius claims she doesn't know the answers and that the government will pull
such information together in November. Given the farce so far, it makes sense
that the CEO of ObamaCare can't or isn't monitoring its day-to-day operations.
But this claim is almost certainly false.
The states
running their own exchanges report enrollment more regularly, which ranges from
the low thousands in big states like California
to a single person so far in Delaware .
Literally, one. And the HHS-run exchanges are designed to make daily reports,
seven days a week.
These
reports are known in industry jargon as 834 transactions and they may represent
the most serious ObamaCare breakdown. Insurers and the exchanges are supposed
to swap electronic files every 24 hours that track the policies consumers
select and their subsidies and check their lists against each other. The
problem is that the exchanges rarely generate accurate 834s.
Our sources
in the insurance industry explain that the 834s so far are often corrupted or
in the wrong syntax, and therefore unusable unless processed by hand. In other
cases the exchanges spit out multiple 834s enrolling and unenrolling the same
user and don't come with time stamps that would allow the insurer to identify
the most recent version.
The upshot
is that the exchanges, the insurers and the consumers will often have different
records on file. These mismatches are an architectural flaw that could persist
for years. The administrative-bureaucratic tangle will only become more complex
as more people enroll, providers start billing insurers, patients show up in
doctors offices thinking they have coverage they don't, and the IRS starts
fining Americans for not having insurance.
***
Before the
rollout, Mr. Obama and Mrs. Sebelius likened the exchanges to a new Apple
product and asked for forbearance as problems were fixed. But Apple doesn't
ship products that don't work and then force everyone to buy them, and a
private business executive who supervised a fiasco like this would already have
been fired.
The crowd
in charge of the country that includes Silicon Valley
ought to be ashamed that they can't produce a serviceable website in 2013. A
useful act of contrition would be to resign, or, failing that, to beg Congress
for a year delay to clean up their wreckage.
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