[Vision2020] E. J. Dionne: Obamacare is Working

[Nicholas Gier]

Please note his initial point: The ACA was designed for states' rights,
just what the GOP always wants, except for now.

E. J. Dionne, 10/27/13, The Washington Post

Obamacare is working.

True, that sentence comes with a large asterisk. It is working in states
that have followed the essential design of the Affordable Care Act,
particularly in Kentucky, Connecticut, Washington and California. The law
was written with states' rights and state responsibilities in mind. States
that created their own health care exchanges - and especially those that
did this while also expanding Medicaid coverage - are providing health
insurance to tens of thousands of happy customers, in so many cases for the
first time.

Those seeking a model for how the law is supposed to operate should look to
Kentucky. Gov. Steve Beshear, a Democrat in a red state, has embraced with
evangelical fervor the cause of covering 640,000 uninsured Kentuckians.
Check out the website - yes, a website -
www.governor.ky.gov/healthierkyfor regular updates on how things are
going there.

"We're signing up people at the rate of a thousand a day," Beshear said in
a telephone interview. "It just shows the pent-up demand that's out there."

Beshear urges us to keep our eyes on the interests of those the law is
intended to serve, our uninsured fellow citizens. "These 640,000 people are
not some set of aliens," he says. "They're our friends and neighbors ...
some of them are members of our families." As for the troubled national
website, Beshear offered this: "If I could give unsolicited advice to the
critics, and maybe to the media, it's: Take a deep breath."

Wise counsel. But there can be no denying the system failure that is a
profound embarrassment to the Obama administration and threatens to
undermine all the good the law could do, since its enemies will use any
excuse to discredit it.

Much is inexplicable about how the administration blew the launch. Everyone
involved knew that this is President Obama's signature achievement.
Everyone knew that the repeal crowd would pounce on any difficulty, let
alone a massive set of tech problems so easy to mock in an age when
everyone has views as to what an online experience should be like. Everyone
knew going in that this was a complicated endeavor. It is very hard to
understand how the officials in charge could risk ignoring the red flags
they apparently saw before the site went live.

Some explanations, however, are obvious. The federal government was not
supposed to be running this many insurance exchanges. You might have
expected that Republican governors who cherish the prerogatives of the
states would, like Beshear, welcome the chance to prove that this
free-market approach to providing insurance coverage could thrive.

Instead, bowing to Tea-Party obstructionism, most Republican governors took
a powder. According to the Commonwealth Fund, only 16 states, plus the
District of Columbia, have fully state-run marketplaces. Among the
remaining 34 states, 19 are fully in the federally run marketplace, seven
states have state-federal partnerships, and another seven are helping
manage federally facilitated marketplaces. Utah is running a small-business
marketplace, leaving individual plans to the feds.

Needless to say, the federal government wasn't ready for this staggeringly
complex task. Consider that individual states didn't have to worry about
any other jurisdiction's insurance laws. The feds had to deal with
sometimes vast state-to-state regulatory differences. I am told that an
estimated 55 contractors and subcontractors had to collaborate on different
aspect of the project. Reportedly, they all claim that their part of the
enterprise works fine. It's the interaction with the other pieces, they
insist, that's problematic.

Let's imagine what a functioning political system would do now. First, we'd
fix the site. Beshear and other governors are showing that the law can get
the job done. Washington officials should look at the successful state
exchanges and simplify the federal exchange as much as possible.

Second, Congress and the White House should use this breakdown as an
opportunity to examine how the federal government acquires information
technology. Are private contractors delivering what they're paid for? Is
the system biased in favor of certain big contractors with long-standing
government relationships? The feds spend roughly $80 billion on IT systems.
Are taxpayers getting their money's worth?

But it would be unconscionable to give up on the goal of expanding the
ranks of the insured simply because of tech failures. "They're not going to
walk away from this," Beshear said of Obama administration officials, "and
we're not going to walk away from this." Thus the spirit of a country that
sticks with solving a problem, even when things get hard.
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