The Obamacare Website Still Won't Work

Photo courtesy of the White House

The past couple of months have been pretty rough for the Affordable Care Act. President Obama's signature health-care reform law barely limped out of the gates last fall, a slow-moving trainwreck plagued by bureaucratic incompetence, disastrous branding, and a completely nonfunctional website. Even some Democrats, recognizing political kryptonite, had started to openly revile Obamacare. So it was hard to blame the Obama administration for celebrating the news yesterday that more than 7 million Americans—7,041,000, according to White House Press Secretary Jay Carney—had signed up for insurance plans through the federal and state marketplaces as of March 31, the final day to enroll in Affordable Care Act coverage for 2014.

The number, driven in part by a huge surge in signups in the final days before the deadline, actually exceeded original enrollment projections, which had been lowered to 6 million because of the website catastrophe. Obama practically ran a victory lap around the Rose Garden Tuesday, declaring “The debate over repealing this law is over. The Affordable Care Act is here to stay,” and in a final, sanctimonious fuck-you to Republicans, he added: “History is not kind to those who would deny Americans their basic economic security. Nobody remembers well those who stand in the way of America’s progress or our people. And that’s what the Affordable Care Act represents.”

It’s an admittedly surprising turnaround for a law that has mostly been a huge headache for Democrats and the White House. But Obamacare isn’t out of the woods just yet. In fact, despite the 7 million enrollments, the Affordable Care Act, and particularly the Healthcare.gov website, is still a mess. In the final hours leading up to Monday’s deadline, the site crashed twice, locking out hundreds of thousands of Americans trying to sign up for coverage. After going offline for scheduled maintenance Sunday night, the site was down until after 8 AM Monday because of software problems. Four hours later, the site went down again, this time due to a bug that prevented new users from starting applications, according to a spokesman for the Centers for Medicare and Medicaid Services. Access remained limited throughout the afternoon, as high traffic throttled the site and sent new users into digital “waiting rooms.”

The message new users got when they visited the Healthcare.gov site on Monday afternoon

At this point, it’s still unclear what exactly caused the outages, and why the Obama administration still can’t figure out how to get Healthcare.gov working smoothly. Officials at CMS, the agency that oversees the federal marketplace, declined to provide more details on what caused Monday’s outages, but a Wall Street Journal report cited sources claiming that the problems were caused by software glitches to how the system processes enrollment dates and lets users create accounts.

Insurers and administration officials now face the complicated problem of figuring out how to enroll people who were locked out of the health-care website or were unable to complete applications by Monday’s deadline. The White House announced last week that it would extend the open enrollment period for “individuals with special circumstances” who began applications before March 31. But the federal government has offered little guidance to consumers or insurers about how those extensions will work or what the new deadline will be.

For insurers, the squishy enrollment deadlines are further complicated by the fact that CMS still hasn’t finished building out the back end of the health-care website, which handles the bulk of the marketplace functions—that is, handling insurance subsidies and compensation for health-care plans and actually confirming enrollments. “Right now, the contingency plan is a manual process between the carriers and CMS,” said Dan Schuyler, a consultant with Leavitt Partners who has advised states and insurers on the health-care exchanges. “If you think about the '7 million people' who've applied, that's 7 million transactions that have to transpire manually between CMS and the issuers. That's a pretty burdensome process."

Beyond the technical issues, big questions remain about whether the law will actually work. As the White House pointed out Tuesday, the future success of the Affordable Care Act depends less on how many people gained coverage than on who those people are—that is, did enough healthy people sign up to offset the costs of sicker people? “At first blush, the national numbers show that enrollment is generally in line with those early projections of 6 or 7 million enrollments,” said Jenna Stento, a senior manager at the consulting firm Avalere Health. “But the real question is who those people are and how they align with what insurers projected as they made their rates. That's what's really going to affect Obamacare in 2015.”

But the biggest question is whether people actually like the health-care coverage they get from the federal and state marketplaces. For months, Republicans have been trotting out a parade of Obamacare “losers”: people whose plans were canceled and who are now forced to pay more for coverage on the exchange. But Stento points out that even those who were supposed to benefit most from health-care reform could end up turning on Obamacare when they learn that their provider networks are limited, or that their high deductibles force them to fork over huge out-of-pocket payments before their coverage kicks in.

“These are very significant issues,” said Stento. “It’s going to come down to whether patients can actually get to a doctor that is in their network and what kinds of costs can they expect once they actually get there."