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U.S. News: Troubled Debut of the Affordable Care Act

Website glitches, cancelled insurance plans make for a rocky rollout of the Affordable Care Act

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President Obama's signature law, the Affordable Care Act, survived a legal challenge before the Supreme Court in 2012 and a maneuver in October 2013 by House Republicans to defund the law (the effort led to a 16-day government shutdown). But perhaps the biggest threat to the law resulted not from opponents of Obamacare, but from preventable stumbles by the Obama administration itself: major technical glitches with the health-exchange website, healthcare.gov, and the cancellation of millions of policies despite Obama's earlier promise that people would be allowed to keep the insurance they had before the rollout of the ACA.

The problems with the website were widely reported from the day the site went live, on Oct. 1. Users complained of having to create an account before they could browse plans, difficulty creating these accounts, repeated crashes, error messages, the site timing out, glacial load times, and other inconveniences. They also reported trying—and failing—to access the site more than 20 times and getting up at dawn to try to beat the crowd. Some who were lucky enough to access the site and log in received incorrect eligibility information. In addition, insurance companies reported several errors in the information they received from consumers. Henry Chao, chief digital architect of the site, acknowledged on Nov. 19 that 30% or 40% of the website still had to be developed. "We still have to build the financial management aspects of the system, which includes our accounting system and payment system and reconciliation system," he said.

Obama acknowledged the ongoing failure of the website, and Kathleen Sebelius, the secretary of health and human services, received a dressing down in testimony before Senate and the House committees. She took full responsibility for the problems. "Hold me accountable for the debacle. I’m responsible." During her House appearance, healthcare.gov was down, displaying this message: "The system is down at the moment. We are experiencing technical difficulties and hope to have them resolved soon. Please try again later." The timing of the alert aptly illustrated the ongoing issues and provided critics with additional fodder. Sebelius blamed much of the site's problems on inadequate testing. "Clearly we did not adequately do end-to-end testing," she said.

On Oct. 22, Sebelius appointed management expert Jeffrey Zients and a team of tech experts to fix the site. Zients was charged with the daunting task of managing the overhaul of the site and making it fully functional by Nov. 30, leaving about three weeks for millions of people to sign up for insurance that will take effect on Jan. 1, 2014. In a report issued on Nov, 30, the Obama administration announced that the functionality of the site had vastly improved. It could handle about 50,000 users simultaneously, was working 90% of the time, the number of daily visits reached 800,000, and load times decreased from 8 seconds to 1 second. However, the backend problems continued and insurance companies still reported problems with the information they received from users. By the end of December, about 2.1 million people had signed up for healthcare under the ACA, with about half using healthcare.gov and the other half using state exchanges.

State exchanges functioned much better. Originally, it was expected that states would their maintain their own exchanges, but states that opposed the law were less inclined to do so and instead relied on the federal exchanges. During the first month the site was open for business, only 106,185 people signed up for insurance under the ACA. Of those, 79,391 bought plans through state exchanges. The White House had anticipated about 500,000 people would enroll in October.

Broken Promise Dogs Obama

The president was quoted several times over the past few years saying that people who were happy with their insurance could keep their policies. However, beginning in October, as many as 5 million people were informed that their policies were being cancelled and had to buy new ones on either federal or state exchanges. Policies were cancelled mainly because they didn't meet minimum standards set forth in the Affordable Care Act. Obama was sharply criticized by Republicans and Democrats alike for the broken promise. On Nov. 14, he announced that the cancelled policies would be reinstated for a year, but said that some of these policies would actually be more expensive and offer fewer services and less coverage than what they could buy on the exchanges. The following day, 39 House Democrats joined Republicans in voting for a bill that would dismantle Obamacare.

Here are some additional facts and stats about the rollout of the Affordable Care Act.

  • According to figures from the Kaiser Family Foundation, nearly 29 million people are eligible for coverage under the Affordable Care Act. About 17 million of these people will qualify for a subsidy.
  • People who earn less than 400% of the federal poverty level ($94,200 for a family of four) qualify for subsidies in the form of advanced premium tax credits. Those who make under 250% of the federal poverty level ($58,875 for a family of four) are eligible for lower premiums up front.
  • People earning below 138% of the federal poverty level ($32,500 for a family of four) receive coverage through Medicaid.
  • People have options other than healthcare.gov to sign up for insurance. They can sign up in person, over the phone, or by mailing in a paper application.
  • The federal exchange serves 36 states. Eleven states are running their own exchanges. Other states either offer their own exchanges or partner with the federal government or other states.
  • The 11 states that manage their own exchanges accounted for about 75% of the enrollment in the first month. Their population makes up about 30% of the total U.S. population.
  • Almost 50 million Americans are uninsured.
  • The White House expected about 7 million people to buy health insurance under the ACA by the end of 2014.
  • The Centers for Medicare and Medicaid Services oversaw the development of healthcare.gov. However, there was no one project leader responsible for managing the site.
  • The White House hired 55 federal contracting firms to worked on healthcare.gov.
  • Given the problems with the website, the deadline for signing up for insurance for coverage on Jan 1, 2014, was extended from Dec. 15 to Dec. 23.
  • On Dec. 31, 2013, Supreme Court Justice Sonia Sotomayor issued a temporary injunction exempting some religious-affliated organizations from being forced to provide insurance coverage for birth control for their employees.
—Beth Rowen

Information Please® Database, © 2007 Pearson Education, Inc. All rights reserved.

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