For a good idea of how anxious Obamacare supporters are about the law's rollout, read former White House health adviser Ezekiel Emanuel's op-ed in The Wall Street Journal this morning:
Transforming the U.S. health-care system—which is larger than the economy of France—is one of the most daunting administrative tasks government has ever confronted. There will be bumps in the road; this is inevitable.
Setting up the exchanges will pose a host of technological challenges, such as digitally linking an individual's IRS information (which determines a subsidy level) to the insurance offerings in the individual's home area and to employment data—while simultaneously factoring in Medicaid eligibility.
Bugs in the computer software are bound to pop up, and the quality of the user experience will undoubtedly need improvement. Indeed, the Department of Health and Human Services has already improved the enrollment forms by reducing them to three pages from 21, and made them easier than the forms used by private insurers. But IT problems aren't the ones that should keep you up at night. Such glitches will be ironed out within a few years, and certainly by 2016 browsing your health-insurance exchange will be very much like browsing Amazon and other online shopping sites.
Got that? Obamacare's primary innovation—the health insurance exchanges—will probably work just fine…by 2016. This is not exactly confidence inspiring, and it suggests why some Democratic legislators are now openly worried about the law's implementation process.
As with a lot of what we're finding out about the law now, it would have been nice if the administration and its supporters had admitted this a few years ago. But "Let's pass Obamacare even though half its coverage expansion probably won't have much effect on health and the exchange technology will be dysfunctional for the first couple years" probably wouldn't have been as convincing an argument.