In news that likely shocks no one, as of this writing, the Obamacare marketplaces have troubles.
That may not be an entirely bad thing for Obamacare.
Ordinarily, a much-heralded website launch that doesn't work for days might be considered a disaster. But these aren't exactly ordinary times. Obamacare is about to get real to the American people, after years of advancing, large and vague, on the horizon, and the political battle is — well, you know all about that. Public perception at this moment matters enormously.
(According to this report, American public opinion is currently nearly deadlocked on Obamacare.)
In that environment, the rocky launch does this: It underscores how many people are trying to get onto the site, which constitutes a major point for supporters of Obamacare. And it delays full exposure of the details involved, which could be a decidedly more mixed bag on the national scoreboard.
Those of us who have been following Obamacare assiduously have had months of the slow reveal, as state after state released specifics of marketplace plans and the feds stayed mum about the 36 states where they are running the marketplace. We saw rival analyses of the revealed info from the left and from the right, and then at the end of September the feds gave us the first glimpse of data for those 36 states, announcing that, generally speaking, they were coming in below what the Congressional Budget Office had predicted.
The thing is, we're distinctly a minority. Many Americans have no idea what Obamacare is about or, worse, are badly misinformed. They haven't been reading all the studies or even the reports on all the studies, and they're not going to start, and they almost certainly are not going to withhold judgment for the several years that experts say it will take to fairly assess how Obamacare is going to shake out.
They are going to hear that Obamacare is here now — many, I'd guess, by way of the marketplace notification that employers were required to supply by Oct. 1 — and they're going to see if they are better or worse off than they were before, which will mostly be a financial calculation. And if they weren't already pro or anti, they'll move out of neutral and choose up sides.
They can't really do that until they enter their data and see their numbers. To date, that has been at best quite difficult on the federal marketplaces, although the phone support is reportedly better than the website. The feds did finally release extensive lists last week, but it was all premiums — nothing on those other vital components of health insurance, the deductible and the copay and the coinsurance and the network. And, of course, subsidy — although people can get a good idea of that number from this calculator.
The marketplaces are going to have to be working well before the masses have all of the information needed to calculate their 2014 positions. And when they do, for some — including some antagonistic to the law — the figures will undoubtedly be pleasant. But for others, they will be unpleasant.
I suspect that many people who don't know much about the law will have expectations rosier than the marketplace reality, particularly in states like Pennsylvania that have not expanded Medicaid.
To people who live and breathe this stuff, reduction in the growth of health care cost increases is significant — although not without controversy. But to average Americans, who don't understand very much about this at all, health care is already too expensive. And if they've been hearing phrases like "affordable care" and "free preventive care" and "expanded access" and "subsidies," they may very well be looking forward to Obamacare decreasing their current out-of-pocket costs. And that won't happen for everyone, by a long shot.
Compared to that complicated conversation, being able to tout the millions of people who are visiting healthcare.gov sounds pretty good right now, I'd say.
Then again, Obamacare would benefit enormously from having a strong show of competence on its record. And the marketplace opening would have been a superb time for that.
Other, less-connected thoughts on the subject.
• So, those millions of people visiting healthcare.gov. Lots of people actually are looking to get insured, I'm sure. But also many people like me and insurers and investors who are dying to get their hands on the full data that, particularly on the federally facilitated marketplaces, has so far been elusive. I understand why it would have been difficult, but it sure would have been fabulous to have some kind of data dump on that. Or to be able to browse the info without doing a full login on the site.
• Sometimes I wonder how different the Obamacare conversation would be if the law had been a little less ambitious. Set the employer mandate at 35 hours instead of 30, for example. Skipped the contraception mandate. Set the bar on what constitutes a qualified health plan a bit lower. Would we still be where we are today? Would it have blunted or sharpened the law's overall effectiveness?
• Object to giving the government your data for Obamacare on principle? I generally see that as an extremely weak argument, most likely advanced by those who doesn't fully understand that health status isn't a factor on these marketplaces, which are selling private insurance. If you pay taxes, it already knows a whole lot more about you. Unless you really object that strongly to telling the government whether or not you smoke.
But object to giving the government your data for Obamacare because of security concerns about the healthcare.gov website? With the range of errors I've personally experienced on that site since Oct. 1, I'm not super inclined to scoff at that one at the moment, particularly as I'm kind of glad I haven't entered my Social Security number on the site — which, I should note, marks it as optional.
• There hasn't been a lot of media attention on this, but, to quote this article, "eHealth and four other online brokers inked a deal with the federal government to sell Obamacare policies and link their customers to the subsidies." But apparently that arrangement didn't include a stipulation that the brokers play nice: "eHealth CEO: Gov't Will Fail at Obamacare Exchanges."
• Also not getting a ton of press: The fact that, coinciding with the Obamacare marketplace opening, insurers have been plugging their own online platforms for people to purchase insurance. Frankly, I'm losing track of whether these are newly launched or not — certainly we've been hearing that they're coming for a while. But in any case, they're here now and interesting and trying hard to be helpful — and, generally, noting that they offer plans that can qualify for subsidies if purchased through the Obamacare marketplace.
Also interesting: Geisinger Health Plan noted that its private exchange will expand to include employers with 2 to 50 employees by Nov. 1. As you may recall, the feds announced that Obamacare's small-business health option program marketplaces would not be fully up to speed on Oct. 1 but that "All functions for SHOP will be available in November."
• Finally, last week did bring good news for some people: "Despite last week's official entry into a government shutdown, for-profit hospital stocks soared through the roof."