Don't Give Up on the Uninsured

Affordable Care Has Come

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 healthcare 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 -- for 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.

(c) 2013, Washington Post Writers Group

About the Author

E. J. Dionne Jr. is a syndicated columnist, professor of government at Georgetown University, and a senior fellow at the Brookings Institution. His most recent book is Our Divided Political Heart: The Battle for the American Idea in an Age of Discontent (Bloomsbury Press).



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For those who are invincibly opposed to the Affordable Health Care Act, it will never be satisfactory or adequate. Meanwhile in cooperating states people are able to access enrollment sites and are actually signing up for coverage programs never before available to them. The logjams are mostly on the federal site where overwhelming activity has slowed and crippled overloaded systems. 'Take a breath' is the best advice especially for the media looking for a new controversy. Our local TV newscaster had the audacity to demonstrate on live TV how to enroll in Covered California, our state's exchange. In a 5 minute segment, he had registered simply, received a spread of comparative options and was given an opportunity to either enroll or print out his options. No mess, no fuss, no confusion. It is obvious that a lot of disinformation is being spread around and a lot of non-cooperation is the GOP's answer to crippling this roll-out. It is time for some good news stories about people getting coverage who never before could overcomre pre-existing condition rejection and lack of affordability.

I think there is some non-cooperation, though not all Republican governors are hostile. Michigan's Rick Snyder tried to set up a state marketplace well in advance of the federal one, but was nixed by his own party. There are varying degrees in which states can participate in the market place. The Commonweal Fund lists these on an interactive map:

Is the Web site a mess? It has been for me; the site crashes before I can complete an application. Meantime, I can now at least click "See Plans Now" and get some ball park info. The bad news is that most of these plans are still way too expensive for those of us low-wage-ineligible-for-Medicaid earners. My strategy will be to buy the cheapest (and probably crummiest) plan possible, and then use the subsidy to trade up when the next enrollment window opens. 

I'm not a fan of the ACA; it's unintended consequences have cut my part-time work even further. But the outrage GOP leaders have shown over the Web site fiasco is laughable. There have been many more moderate health care insurance relief measures that have been proposed over the years (everything from individual medical savings accounts to dollar-for-dollar tax rebates on some medical expenses to putting Medicaid on a sliding scale basis). Republicans have consistently rejected these plans, often branding them "socialized medicine."

So the very expensive, clunky, confusing Big Government deal they got with Obamacare is partly their own fault. 


I can't help but wonder if there were politically motivated denial of service attacks on the ACA web site.  Which is not to say that the site should not have been prepared for such.

Of course the governemnet is going to fix the technical problems. But E.J., come on, blaming the Tea Party for the problems is just another example of your penchant for making excuses, or apoligizing, for Obama. There were no conspiracies here, just poor planning. And no one had the temerity to tell the Emperor he wasn't going to have any clothes!

The GOP and Fox news is 24-7 blaming Obama for the website. They never mention that it was their beloved private business contractors who  set up the site. They also never mention it was private contractors  hired and failed to defend the Consulate and safe house in Benghazi. That is why we knowledgeable think their political tactics always smell and will be long remembered. .

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