New Orleans This is the Chief Organizer, not Rebecca of Sunnybrook Farm, so let’s start by not pretending that the first two weeks of enrollment under the Affordable Care Act have been anything other than bad. They have been woeful. At the same time in my view none of the problems are fatal, all of them can – and will – be fixed, and most of the pressure on the system is still in the future as outreach efforts start to have impact, not with the first shoppers that were crowding the door.
A lot of this was predictable, contrary to all of the claims by the private contractors and the government. I firmly believe that no one who has ever put in a new computer or web-based system anywhere has ever found that it cost what was advertised, arrived when expected, or worked perfectly the first time out. For all of the web boosterism, this is the real wide world of web work, not the pie-in-the-sky stuff of advertisers and hucksters. So, seriously, sports fans, didn’t everyone know there were going to be some sniffles on the startup? Come on, man!
Contrary to most Debbie Downers out there that believe that we already have “discouraged” shoppers given the snafus of the first two weeks, I think the first customers rushing in were a combination of people who had been shut out in the past because of prior conditions and the curious. The shutouts are going to have to keep trying. Realistically, they don’t have any other choice. Stories reported in the press have invariably interviewed people who have been previously shutout of the system and indicate that they have been the most persistent in continuing to try and get through the morass. The curious will come back when they hear that the coast is clear.
The real uptick in application volume is going to come as the efforts to reach people who are eligible but unaware and uncertain of how to proceed, start to get traction. This will happen through the mass outreach efforts of the navigator and other programs. None of those efforts were ready to rock by the starting bell. From what I have heard, for most of them, the actual money on the grants came almost two months after the grants were awarded, so how could these efforts have been in earnest? Commitments for distributing millions of flyers are still unfulfilled and delayed. State efforts in many places to obstruct these efforts are still being dispatched. Congressional intimidation of HHS is attempting to forestall some of the direct outreach efforts that are going to be the most effective. Like the software problems, this is a process of problem solving and eventually all of this will come together so that the masses of eligible beneficiaries of the program will start to find clear paths forward.
That’s not to say that it will be easy. For example using paper applications gets people into the system, but to select their insurance company, folks will still have to go on-line to compare and choose. That doubles or triples the outreach effort, snarling the process as well. People also told me that HHS outreach materials are on backorder and are now 6-weeks late on delivering the literature for outreach for volunteers who want to help out, so it could be November before these efforts hit home.
My bet is that the government is going to have to extend the enrollment period past March 31st of 2014, because people should not be assessed penalties for delays that were caused on the front-end by the system itself, and, frankly, that’s fine too. This is not a one-year race but a multi-mile marathon to bring health coverage to the American people, and there’s really no question that we will win this race at the finish line, even if we have to move it back a bit.