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More short takes on Obamacare...

…starting on our homepage with “A Good Start,” by Charles R. Morris: 

There is no reason to expect it to go smoothly. It took a year to sort through the mass confusion surrounding George W. Bush’s Medicare Part D program, which was a far simpler challenge, since all the eligible patients were already known to Medicare. The ACA, working through an array of exchanges run by the states and the federal government, must create new databases of individuals and businesses, apply new eligibility rules, qualify hundreds of benefit plans, and match eligible recipients and plans. Plans and rates will differ substantially from state to state. …

But the overall prognosis for the law’s success is still bright. The states that have embraced the law seem determined to make a good show of it. Their exchanges will be ready to open on the first of the year, and though there will certainly be glitches, most of them should be operating fairly smoothly by the summer. Even better, the first exchange insurance prices are lower than even friendly analysts expected. …

The performance of the federal exchanges may well lag that of the participating states, since hardly anyone imagined that almost two-thirds of states would opt out. But the feds will catch up—among other things they will mostly be able to apply the same basic data systems in every state. Over time, Republicans may rue the boost that the opt-out red states gave to the creation of a national health-care system.

Ezra Klein at the Washington Post on how demand for Obamacare is what really troubles those who would defund it:

It was strange and slightly perverse to watch Obamacare open and be flooded with people desperate to sign up for health insurance even as the government closed because Republicans wanted the law ripped out, or at least delayed. In some quarters, Republicans mocked Obamacare’s technical problems, but the jokes were wan: Overwhelming demand for the law is not a boon to the GOP’s position.

This is, of course, precisely what Republicans were scared of: That a law they loathe would end up being enthusiastically embraced by millions of Americans -- and thus proving permanent. It’s Obamacare’s possible success, not its promised failures, that unnerve the GOP.

Eduardo Porter in the Business section of today’s New York Times sees it similarly: 

[T]he argument that half the Republican Party has simply lost its mind has to be an unsatisfactory answer, especially considering the sophistication of some of the deep-pocketed backers of the Tea Party insurgency.

There is a plausible alternative to irrationality. Flawed though it may turn out to be, Obamacare …could fundamentally change the relationship between working Americans and their government. This could pose an existential threat to the small-government credo that has defined the G.O.P. for four decades…. [T]he law has many provisions that are likely to improve life for millions of Americans, including a big portion of what we know as the working middle class.

As it turns out, the core Tea Party demographic — working white men between the ages of 45 and 64 — would do fairly well under the law….

To conservative Republicans, losing a large slice of the middle class to the ranks of the Democratic Party could justify extreme measures.

And extreme (and slightly garbled) rhetoric.

Texas governor Rick Perry, in New Jersey stumping for U.S. Senate candidate Steve Lonegan, called implementation of the ACA a “criminal act.” “If this heath care law is forced upon this country, the young men and women in this audience are the ones who are really going to pay the price. And that, I suggest to you, reaches the point of being a felony toward them and their future.” 

Kevin Drum looks at how corporate employers might like to exploit glitches and the complexity of the rollout: 

For the past year or so, Obamacare has been the perfect foil for every corporation in America that’s done something unpopular with its benefits package. In the past, they were forced to vaguely blame their handiwork on “rising prices” and leave it at that, but now they have something better. Cutting back on benefits? Obamacare! Raising copays? Obamacare! Reducing hours? Obamacare! Whatever it is, all they have to do is say that it’s a response to Obamacare. CEOs and HR directors across the country are pleased as punch that for at least a little while, they can plausibly deflect criticism for things they were probably planning to do anyway. It’s been a godsend.

Deroy Murdoch at The Corner gets in the predictable barbs while equating IT glitches with creeping, unworkable socialism: 

Arizona, Florida, Texas, and 22 other states have resisted Obamacare, and basically told Obama that if he wants exchanges in their jurisdictions, he can go ahead and erect them. In contrast, New York and its liberal-Democrat-dominated state government designed its exchange website with enthusiasm and a collectivist sense of purpose. So, if this is as good as Obamacare gets in a cooperative, pro-socialized-medicine state, imagine how things will unfold in places where state officials actively drag their feet on Obamacare implementation.

After just two days, Obamacare already resembles the wheezing, unresponsive, morbidly obese monster about which Republicans and free marketeers have warned consistently for three and a half years.

Jonathan Cohn acknowledges the glitches are real—and says they don’t matter:

Consider what happened in Kentucky—a state where, despite the state’s conservative political currents, leaders are setting a standard for how well Obamacare can work. According to officials there, the new “Kynect” website logged more than 57,000 unique visitors on Monday, with each person staying on the site for an average of 11 minutes. More than 2,000 people started applications and more than 1,200 completed them. In Arkansas, consumers filed into a help center at the University of Arkansas to find out about their new options. The online systems were down, making on-the-spot enrollment impossible. But, according to an account by David Ramsey in the Arkansas Times, people said they could wait until the system was working. …

Buying health insurance on the individual market has always been frustrating and difficult. In most states, it has required filling out lengthy forms on medical histories—sometimes forcing people to recall specific doctor visits and treatments, with the threat of denial or policy cancellation even for inadvertent omissions. And that’s not to mention that insurance companies frequently took weeks and even months to process applications. Or the fact, that when the process was done, many people simply couldn’t get coverage because they had pre-existing conditions or simply couldn’t afford the premiums.

Republicans and their allies are reveling in Obamacare’s implementation glitches. But their solution isn’t to provide people with some easier, quicker, and more reliable source of insurance. It’s to replace a system that has some early, fixable technological problems with no system at all. It’s to stop people from getting health insurance—and take it away from those who are already getting it.

About the Author

Dominic Preziosi is Commonweal’s digital editor.



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I agree with Cohn - website issues usually are fixable, and should be fixed relatively quickly, if the folks who support them are reasonably competent.

I would guess that at least a fair amount of the website traffic on the first day were goofs like me who were idly curious but aren't really in the market for health insurance.  Let's see how much traffic there is today and the next few days, and how well the systems handle it.  What should worry the admininstrators is not first-day traffic jams, but the ability to handle traffic as the final days for enrollment approach.  I read somewhere recently that the myth that young, healthy people would wait until they are sick to buy Obamacare insurance is a canard, as in reality the law provides for the equivalent of an "open enrollment period" that ends sometime early in calendar year 2014; people who miss the enrollment period are out of luck until the following period.  If that's not correct, I hope someone here can provide a correction.


One of the points Jonathan Chait made yesterday is that, by forcing the shutdown, the GOP was stepping on the bad press of what was likely to be Obamacare's worst day. In a saner time there would have been a lot more "analysis" like Deroy Murdoch's, disingenuous but effective: Har har, the website is down, where's your hope and change now?

But Jonathan Cohn is also right that it's hard to shock people with technical glitches when we've all experienced the pre-Obamacare reality of having, or trying to get, health insurance. There's a half-hour line? The form can't be filed immediately? That's your big-government nightmare? Let me know when you've got something to report that doesn't sound better than my best day dealing with Aetna or United.

I teach a community college class in a college whose student body is mostly low to moderate income.  My students have been asking me all kinds of questions about how to enroll, and they are disappointed when they learn that coverage isn't effective until January.  Young people already know how dangerous it is to be without insurance, and they know that individual policies under the current system are unreliable.  Governor Perry's idea that this is a felony on the young is out of touch with reality.

The local news in my area of Michigan is running all sorts of anecdotal reports--people who  can't get on, people who say the premiums are still too high, people complaining about the deductibles, people whose current insurance carriers are cancelling policies and going out of business because they can't meet ACA requirements, people who qualify for subsidies but can't find out what those subsidies will amount to. It makes everything sound more confused, disorganized and negative than it might actually be once things calm down..

I'm holding off on visiting the exchange for a week or two in hopes some of the glitches will be worked out by then, and I'm not taking first reports or punditry too much to heart at this point. 

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