The Two Scenarios That Would Have Improved the Obamacare Launch

After two weeks of examining the flaws in the Obamacare exchange roll-out, there are two scenarios that could have saved everyone a whole lot of trouble. One, the federal site could have allowed users to browse the exchanges before registering. Or two, more states could have been more committed to making the Affordable Care Act successful and built their own exchanges. 

If users could browse Healthcare.gov before registering

The Wall Street Journal offers the most definitive look yet at why Healthcare.gov doesn't quite work. The anonymous faulty private contractor software component acknowledged early this [image error]week was Oracle Identity Manager, designed by Oracle Corp. When users submit their data into the system, it is transferred to Quality Software Services, which subcontracted Oracle to design the faulty component. Oracle released a statement saying their software is working, but sources ("other people") told the Journal that "the other systems are not interfacing consistently with the Oracle software," which is preventing people from registering.

Originally, the plan was to allow users to browse for insurance before registering, but that tool was delayed and the site launched without it. That was maybe a bad idea. From the Journal: 

The decision to move ahead without that feature proved crucial because, before users can begin shopping for coverage, they must cross a busy digital junction in which data are swapped among separate computer systems built or run by contractors including CGI Group Inc. the healthcare.gov developer; Quality Software Services Inc., a UnitedHealth Group Inc. and credit-checker Experian. If any part of the web of systems fails to work properly, it could lead to a traffic jam blocking most users from the marketplace.

Officials identified the Oracle issue on October 2, but it hasn't been resolved yet. But that bottleneck wouldn't be happening (or wouldn't be as bad) if users could browse first. As some experts pointed out, when you have a complicated series of systems exchanging information with each other, you want to leave that for the end of the registration process, not the beginning. One explanation offered by an HHS spokesperson is that the agency wanted users to see their subsidy eligibility before they browsed the prices, requiring them to register. That's a fair point (people might be scared off by high pre-subsidy rates) but if user can't get to through the registration process, it doesn't matter. At some point on Thursday healthcare.gov introduced a very basic window shopping tool, but unlike some state-run exchanges it doesn't tell you what your co-pays, deductibles or subsidies will be. For that information you still have to register.

If only more states built their own exchanges

[image error]Of course, some states have had a much easier time enrolling their uninsured in healthcare. That's not because they're lucky, or the the coding gods smiled down on their enrollment sites and said, "Go forth, and be glitch free." It's because those states actually made a good faith effort to make enrollment in Obamacare as simple as possible. The roll-out hasn't been perfect, but most of the glitches have been fixed.

Let's compare California and Florida. Both have millions of uninsured residents (7.1 million uninsured in California and 3.5 million uninsured in Florida). But while California is as blue as a state can be, Florida has a Republican governor and a Republican legislature.

Here's how The New York Times describes California's preparation for the launch:

There are radio and television commercials galore, along with Twitter and Facebook posts and scores of highway billboards. There are armies of outreach workers who speak Spanish, Tagalog, Cambodian, Mandarin and Cantonese, all flocking to county fairs, farmers markets, street festivals and back-to-school nights across the state. There are even dinner parties in Latino neighborhoods designed to reach one family at a time.

And here's how The New York Times describes Florida's, er, non-preparation: 

First the State Legislature roundly rejected the law, refusing to create a state insurance exchange and punting it to the federal government to run the new insurance market. It also rejected $51 billion in federal funds that was available over 10 years to expand Medicaid coverage for the state’s poor. As the day neared for consumers to enroll in insurance plans, state officials announced that so-called navigators — a group assigned to help people sign up — would be barred from state health offices just like all other outside groups.

Of the 16 states that have state-run exchanges, or plan to run their own exchanges in the coming years, only Idaho, Nevada and New Mexico have Republican governors, and only Idaho and Kentucky voted for Mitt Romney in the 2012 presidential election. Basically, with the exception of Idaho, all the states with state-run exchanges are very blue. Meanwhile, the 26 states that declined to expand the Medicaid program are mostly Republican controlled. That's not to say that the Obama administration isn't at fault for the flaws with Healthcare.gov — the site was not where it needed to be on October 1. But states like California, which run their own exchanges and actively sought to educate their residents about the program, are having an easier time. Put another way, the exchanges are working in states that want them to work.