What was meant to be a signature piece of Obama’s legacy has turned into an exercise on failed opportunity. Those Americans brave enough to give HealthCare.gov a try have been met with error messages, time out screens, and general uncertainty as to whether they will gain access to the health insurance benefits promised to them. This has only been made worse by the ambiguity and evasiveness of the Obama Administration (and, of course, rants from the Republican opposition).
Many supporters of the law are justifiably frustrated by the bungled rollout, and the blame game is already in full swing. While the Obama Administration and federal contractors tasked with building the consumer interface are busy pointing fingers at each other, the law’s opponents are working to ensure the American public knows every single thing that has gone wrong with the bill’s implementation.
What is perhaps most disheartening about the whole experience is that in many ways, this is a self-inflicted wound. Simply put, the Obama Administration let a reelection campaign get in the way of a successful policy rollout.
Following the passage and signing of the Affordable Care Act (ACA) in March 2010, the Obama Administration then set forth to execute the law by designing and releasing regulations to inform the states, health care companies, and the American public on the details of the bill’s implementation. However, to ease Obama’s 2012 reelection battle, the Administration halted the release of these key rules in the months leading up to November. At a time that was critical for the legislation’s successful implementation, the Department of Health and Human Services (HHS) went dark on the ACA. While this may have helped keep the unpopular law out of the press and off the minds of the electorate, it also caused devastating delays in key information needed to ensure proper deployment of the ACA infrastructure.
To illustrate, a CBS news investigation revealed that from May 2010 to August 2012, HHS released a total of 109 proposed regulations meant to inform the implementation of Obamacare. Starting in September 2012, however, that number dropped to zero until shortly after the November election. Then, almost immediately after Obama’s reelection, a flurry of new critical regulations were released, with a total of more than 60 rules being published over the last 12 months.
Just weeks after the election wrapped up, key regulations related to essential health benefits and health insurance market rules and rate review were released to the public. Alarmingly, the essential health benefits rule had reportedly been ready since early summer but the release was delayed by months. Without this key piece of regulation, insurance companies were unable to finalize the benefit designs and costs of the new insurance plans offered in the new marketplaces.
Federal contractors were also left in the dark, as key information on the details of the consumer interface for Healthcare.gov was delayed until well into 2013. The CBS investigation revealed that nearly one-third of the work done by the contractors had to be thrown out in May 2013 when they finally received the information they needed and realized they had been working under incorrect assumptions.
All of this added up to lost time, money and opportunity. There are numerous other issues facing the marketplace infrastructure, but given adequate time, the Administration could have ironed them out well before the launch date. Everything from the glitchy website to the security risks could have been assessed and addressed months earlier.
By delaying regulation after regulation to ensure campaign news cycles were not dominated by the unpopular law, Obama himself ended up being one of the biggest obstacles to the policy’s success. These delays left key stakeholders without vital information necessary for a smooth deployment of the ACA; insurance companies couldn’t design plans and calculate costs, contractors were left guessing on critical technical requirements and states scrambled to fill information gaps. It is no wonder the rollout has been less than successful.
It remains to be seen if these wounds are terminal, but with the new self-imposed deadline of November 30 for the website to be fully functional, it is definitely time to get down to work.