Obamacare’s Big Implementation Challenges: Affordability, Enrollment, and Technology

WhiteHouse.govWhiteHouse.govIt’s clear at this point that the Obama administration thinks the key challenge in rolling out the health care law this year and next is getting enough young, health adults to sign up for insurance. The administration says they need 2.7 million young, basically healthy adults, a majority of whom are men, to sign up in order to make the law work.  

But it’s also clear that, despite projecting confidence about their ability to convince young uninsured adults to sign up, they face an uphill battle—one that they lack a clear strategy to win.

The big problem is convincing those young adults that insurance is actually affordable. The administration is using data-driven campaign-style demographic and geographic targeting to try to reach out to the population that’s most likely to sign up. But there’s an awfully big difference between convincing someone to show up to vote and convincing them to shell out thousands of dollars a year for an insurance product.

Indeed, supporters of the law seem to understand that convincing those folks will be a significant challenge. In a lengthy piece on Obamacare implementation for The Washington Post, Ezra Klein and Sarah Kliff talk to the founders of Young Invincibles, a group dedicated to getting those crucial young people to sign up for the law, about the market research they've conducted:

They have found, overwhelmingly, that Americans are uninformed about the health law — and are deeply skeptical when they learn about it.

When they asked a recent focus group whether a $210 premium was affordable, only 29 percent of likely marketplace enrollees said yes. Then, Undem and Perry phrased the question a bit differently. They told the focus group participants that, with their tax credits, they would save “$1,908 a year compared to what you would pay on your own.”

All of a sudden, 48 percent of the participants thought that insurance was affordable. But 48 percent is still less than half.

So the best response the folks at Young Invincibles can get still leaves them with more than half of focus-group respondents saying that the premium is unaffordable. And that’s when emphasizing the value of the subsidies rather than on the actual price tag of the insurance itself.

The problem, of course,  is that for the most part decisions about whether to purchase insurance aren’t likely to be made based on the size of the subsidies. Instead, they’ll be based on what the beneficiary pays out of pocket after those subsidies are applied. Add to this the fact that the penalty for remaining uninsured will be capped at just $95 next year, and you have a very tough sell. And the administration's only real defense is basically that Obama is good at reaching young people and convincing them to vote. That's not nothing. But it's not obvious that Obama's campaign successes will translate into health law enrollment success, especially given the administration's persistent inability to sell the majority of the public on the law's virtues. 

The other big challenge for the administration is technical—creating the federal data hub that’s supposed to perform critical exchange functions. There are serious questions about whether even a scaled back version will be operational and glitch-free by the time the exchanges are supposed to go live in October. And the best answer that Klein and Kliff, two of the best connected and most influential health care journalists in Washington, can get is that nobody who actually knows anything will talk:

Even the most tuned-in health care consultants have trouble predicting whether the federal government can get the law off the ground.

“It’s pretty much a black box,” Deloitte’s Cheryl Smith said of the technology that powers the health law. “They tell us, ‘It’s freakishly on schedule.’ They use those exact words. But only the people who work in this can tell you if its actually running on time.”

Given how little information we have, it is entirely possible that the exchange tech will go live as planned on October 1 and surprise everyone with its sleek, smooth functionality. Really! Indeed, because we know so little about the progress being made on the law’s technological infrastructure, critics of the law should definitely not count on certain disaster come October. 

But by the same token, the lack of transparency, and the general secrecy surrounding implementation, ought to make supporters less confident as well, especially given the few tiny snippets of  information we do have: the head of health law IT development admitting he is nervous, the delay of the employer reporting requirement (thus putting off an incredibly complex data management project), the history of missed health law deadlines at HHS, and the uncertainty expressed by the federal watchdogs at the Government Accountability Office, which reported last month that it simply couldn’t say for sure whether the exchanges would be ready on time.

My guess, subject to change with new information, is that the exchanges will open for enrollment on time, but with limited, perhaps extremely limited, database functionality. As for enrollment, it’s difficult to predict with confidence, but it certainly wouldn’t be too surprising if enrollment turns out to be lower than hoped for, or heavily weighted toward sick and expensive beneficiaries.

All of which is to say that there remain a lot of ways that Obamacare can go wrong as it goes live. And despite its projections of confidence, the administration is not offering a clear, compelling case that it is certain to get things right. 

Editor's Note: We invite comments and request that they be civil and on-topic. We do not moderate or assume any responsibility for comments, which are owned by the readers who post them. Comments do not represent the views of Reason.com or Reason Foundation. We reserve the right to delete any comment for any reason at any time. Report abuses.

  • Pro Libertate||

    Repeal. . .with extreme prejudice.

  • Live Free or Diet||

    Even DHS doesn't have enough ammo.

  • Generic Stranger||

    Dust off and nuke it from orbit. It's the only way to be sure.

  • Hugh Akston||

    Ray Kelly will take care of that. Just stop n' frisk everyone in the country darker than a walnut and take whatever ammo they have on them.

  • Sevo||

    Pay wall, but this gal simply reprinted the royal excuses about Obozocare, including one cute response as to whether a 30yo needed to buy insurance or pay the penalty.
    'Not if she makes too little to file income taxes'.
    How droll.

  • Sevo||

  • jester||

    They voted for him, they stood behind PPACA and they still heart the man. Obama's young voters must show up on this or it is the most damning display of ...you choose the phrase, many are available.

  • Hugh Akston||

    PPACA

    wut?

  • Pro Libertate||

    O'Llama Dare.

  • Fatty Bolger||

    House Votes to Postpone Individual Mandate

    A large number of Republicans hate the individual mandate, despite the idea coming from a conservative think tank

    Doesn't that subhead just ooze Democratic media butthurt?

    Newtcular Titties says that this is the beginning of the end for Obamacare. Well, we'll see, but he's right that there are going to be some very conflicted congresscritters over these votes.

  • Anonymous Coward||

    despite the idea coming from a conservative think tank

    Because the Progressives march in perfect lockstep, they imagine everyone else does.

  • The Immaculate Trouser||

    They're just throwing shit at the wall; seeing what sticks and what doesn't.

    That is, btw, a good sign that your propaganda campaign has *failed*. The Bush administration had to do the same thing with OIF once the wheels came off for roughly the same reasons.

  • Gozer the Gozerian||

    "All in all you're just a'nother shit in the wall"?

  • Gozer the Gozerian||

    It's like in Dark City...
    They poke and prod, trying to figure out what makes *them* individuals...

  • Rich||

    The administration says they need 2.7 million young, basically healthy adults, a majority of whom are men, to sign up in order to make the law work.

    Simply bring back the draft.

  • Sevo||

    "The administration says they need 2.7 million young, basically healthy adults, a majority of whom are men, to sign up in order to make the law work."

    Any one taking odds on whether that 2.7m number bares the slightest connection with reality?

  • UnCivilServant||

    That might fund Wisconsin's liabilities.

  • Sevo||

    For those who didn't see it elsewhere, Cuomo swears NY insurance rates are gonna drop 50%!
    http://www.nytimes.com/2013/07.....50.html?hp
    So what's the worry? Cuomo is a genius, right?

  • Gozer the Gozerian||

    Wasn't he the fuck-shit that decided to GIVE AWAY gasoline during a shortage?

    I mean, at least Christie had the good dictatorial sense to ration...

  • Palin's Buttplug||

    Even the government has enough sense to test a system before rolling it out live.

  • Sevo||

    Palin's Buttplug| 7.17.13 @ 5:33PM |#
    "Even the government has enough sense to test a system before rolling it out live."

    Is this the new spin on the delay, shreek?

  • Gozer the Gozerian||

    He just got word from the Obammissar: The "bad weather" excuse doesn't fly anymore -- except with global warming.

  • Auric Demonocles||

    No, you've got to pass it to find out what's in it.

  • Adam330||

    "the penalty for remaining uninsured will be capped at just $95 next year..."

    This is wrong. The penalty for 2014 is the GREATER OF $95 or 1% of household income in excess of the tax filing threshold (will be roughly $10k in 2014). So for a person making $40k, the penalty is about $300.

  • Sevo||

    I think Tucille pointed out it was $295.
    Still 'way cheaper than the insurance, especially since you can sign up for the 'insurance' just as soon as you have an accident or get sick.

  • Gozer the Gozerian||

    You gotta love the creeping semantic inversion for all of these concepts and their relevant government institutions.

    Someone should write a dystopian novel with that...

  • Sevo||

    Maybe 'Atlas something'; nice strong impression.
    Whadaya think?

  • The Immaculate Trouser||

    Nah; too pretentious. A number would be best -- but what could it be?

    42?

    pi?

    198...5?

    1492?

  • Sevo||

    Some time in the future; 2184?

  • Gozer the Gozerian||

    Durr!

    Sheese, guys... Do I have to spell it out for you?!?

  • Sevo||

    Somehow wasn't on my Amazon wish list...

  • The Immaculate Trouser||

    The smart leftists aren't even pretending that this is going to be a political success in the short term. The implementation and litigation problems are staggering even if you assume that everyone working on implementation is doing so with pure motives and not self-interest.

    The dumb leftists... well, the dumb are easily misled.

  • Sevo||

    You mean like this?

    Palin's Buttplug| 7.17.13 @ 5:33PM |#
    "Even the government has enough sense to test a system before rolling it out live."

  • The Immaculate Trouser||

    Exactly like that. You can't cure stupid.

  • Gozer the Gozerian||

    ...Yes, the reason we got this thing in the first place -- and the reason, I fear, we will keep getting it, good and hard.

  • Red Rocks Rockin||

    They have found, overwhelmingly, that Americans are uninformed about the health law — and are deeply skeptical when they learn about it.

    When they asked a recent focus group whether a $210 premium was affordable, only 29 percent of likely marketplace enrollees said yes. Then, Undem and Perry phrased the question a bit differently. They told the focus group participants that, with their tax credits, they would save “$1,908 a year compared to what you would pay on your own.”

    It's telling how deceptive they have to be to make it seem even remotely palatable. No wonder the unions are turning on this dog, now that they're finally seeing the math behind it.

  • Sevo||

    You can argue (if you're sleazy enough) that the Constitution's 'general welfare' clause somehow justifies Obozocare, but HIH do you justify using taxpayer money to test various lies so people will accept a horrible program?

  • Gozer the Gozerian||

    Did you really need to ask...?

    "Commerce Clause"

  • Sevo||

    *Dope slap!*
    Of COURSE!

  • The Immaculate Trouser||

    The (non-pub sec) unions were never in favor of the current healthcare monstrosity. They were pushing for public option, but when it became clear that wasn't going to happen Obama had to corral them into supporting the POS that came out the other side. At the time, passing *something* was seen as necessary lest Obama and the Dems be seen as failures.

    That said, it's their tar baby and they, like the Catholic Church, have only themselves to blame for not torching the bill to the ground when it became clear that it would impinge on their desires.

  • Gozer the Gozerian||

    I ask this both in seriousness and in jest: Do you have any numbers on how many of them get exempted?

  • The Immaculate Trouser||

    It's a waiver process. Last I heard 185 union waivers had been granted, though like most everything regarding the ACA the details of reportage and specifics of how it all works have been in flux from the get-go.

  • The Immaculate Trouser||

    Keep in mind that "last I heard" = about a year ago, so that number is likely much larger today than it was then. However, I think the larger unions got their asses covered early on.

  • Sevo||

    And the Regent can grant as many waivers to friends of the court as the Regent chooses!

  • Gozer the Gozerian||

    It's entirely irrelevant to this discussion, but that just makes me want to play Europa Universalis....

  • ||

    Obamacare’s Big Implementation Challenges: Affordability, Enrollment, and Technology

    Sooo, pretty much EVERYTHING then.

  • PapayaSF||

    I still doubt that they are going to have this thing running in October, in anything like the intended form. It's just too big, interfaces with too many other systems, has big security issues, and government has a grim record when it comes to giant IT projects. Far simpler ones (internal systems for one department) have failed miserably and simply been canceled.

  • Sevo||

    Pretty sure it was a Chron article that mentioned the CA 'choices' are now down to three; all the other providers have bailed from the CA market for the obvious reason that they can't make money. Natch, this means they are horrible companies!
    Anyhow, with that limited number of suppliers, I could see the CA 'exchange' showing up in some form, but then the concern about the staffing is getting real attention, and I've yet to hear anything about the tech end.

  • PapayaSF||

  • Sevo||

    What's TPA?
    I'll hold other comments until I know what that is, but the first lateral connection is enough to scare me immediately!
    Am I right that "Navigator" = "FAQ" = "We're happy to list questions you didn't ask and provide wrong answers!"

  • Dweebston||

    Third Party Administrator, if my googlefu serves. I'm assuming something like what BC/BS does for Medicare.

  • Dweebston||

    Also, I'm less worried about the static FAQ and more worried about the headaches and/or unintentional fraud caused by live operators dispensing incorrect advice a la Medicare billing.

  • PapayaSF||

    I just wonder how they are going to hook up all those different computer systems, and in a secure way, and make them work for the average user. The possibilities for technical screw-ups, mistaken data, confused identities, etc., are endless.

  • widget||

    I get the sense the DOHS is going about the implementation of the ACA the same way JPL goes about building a spacecraft - if it's not invented here it's not good enough. If so, this is going to take a long long long time. When Obama promised that you can keep your existing health plan and doctors, he wasn't kidding.

  • PapayaSF||

    Except that they have to interface with pre-existing databases on systems in other departments. They don't get to reinvent those.

GET REASON MAGAZINE

Get Reason's print or digital edition before it’s posted online

  • Video Game Nation: How gaming is making America freer – and more fun.
  • Matt Welch: How the left turned against free speech.
  • Nothing Left to Cut? Congress can’t live within their means.
  • And much more.

SUBSCRIBE

advertisement