It's less than a week before Obamacare is scheduled to open up to the public and the exchanges are experiencing some technical difficulties — a perfect opening to assign some blame. But to whom? Over at Bloomberg View, Megan McArdle has a few suggestions, mainly: the government. McArdle argues that building out technology behind the health exchanges was "actually very, very hard" and that the government didn't realize that, from passing the law to its implementation. But that somewhat undefined group of bureaucrats doesn't quite get at who really deserves the finger-pointing. We explore.
"Like any law, like any big product launch, there’s going to be some glitches as this thing unfolds... Somewhere around the country, there’s gonna be a computer glitch and the website's not working exactly like its supposed to," President Obama said in a speech on Thursday. But some of those glitches are pretty serious. To allot fault to the proper parties for first requires understanding the glitches. As of right now, there are two distinct areas of malfunction. In Washington D.C., which has elected to run its own exchange, the pricing won't work until November, a full month after the October 1 launch date. Oregon and Colorado have reported similar issues.
In addition, the 36 federally-run exchanges — states that opted out of operating their own exchanges left all the work to the federal government — are having some vague issues, as reported in The Wall Street Journal this week. "The government's software can't reliably determine how much people need to pay for coverage, according to insurance executives and people familiar with the program," the Journal reported, not quite explaining why (or where) the software isn't working. There's also a problem on the small-business exchanges — which are separate from the individual market and therefore we will not include in this stage of the blame game. (Also, this delay isn't totally unexpected, the small business exchange is a lower priority than the individual market and has already seen delays.)
To summarize: There are specific problems with specific state exchanges, and less specific problems with one, some, or all of the federally-run exchanges. Okay, now that we've clarified that, we can get to blaming people.
Insurance Companies: For both state and federal exchanges, health insurance companies had to hand over a lot of very specific information — like rates, plan levels, etc. — around which to build the Internet systems that would work something like Travelocity for healthcare, as McArdle puts it. Since glitches with both DC and on the federal level have to do with pricing, it is possible that the insurance companies somehow provided the wrong data. Or, that the input of this data isn't entirely correct.
Blamability: Medium-Low. This is definitely the least fun institution to blame and also the least likely culprit. See, this would be a relatively easy thing to fix. It's not a technology problem; but an information problem. It's like: When you're doing a math problem and do all the math parts right, but get the wrong answer because you copied the problem down from the board wrong. Instead of having to find the bug and then build out whole new systems, fixing this just requires better data input. The timelines for the fixes — a whole month — suggest that something deeper is wrong.
Government Contractors: To build the exchanges — like actually code the websites — the government worked with a series of contractors. Both the states and the feds outsourced parts of this massive IT project to third parties. These glitches could be a function of bugs in the web development. It sounds like that might be the problem with D.C.'s system, according to their language:
DC Health Link is not currently deploying the function that makes new Medicaid eligibility determinations and calculates tax credits for purchase of private insurance due to a high error rate discovered through extensive systems testing.
Words like "high error rate" and "not currently deploying the function" sounds like tech speak for "there's a bug."
Blamability: Medium. This sounds like the culprit for a lot of the problems. But both of the above explanations don't get to the real reason for the problems. Rather: Why are there bugs this close to launch date? For that we have to go deeper.
Congress: When passing the law, Congress didn't understand the technicalities of what they proposed, argues McArdle. "The fundamental problem," she says, "is that the people who were describing this amazing system seemed to think that if something could be easily described in English, it must not be that hard to do." That might be true, but McArdle doesn't provide much data. Plus, a lot of exchanges are operating just fine, suggesting that even if it is a hard thing to do, it's not impossible.
A more compelling way to blame Congress, however, is for setting the October 1, 2013 date. As McArdle notes, three years is not very long to build 50 exchanges. That timeframe had its political value, "They didn’t want to risk letting Republicans get into office and screw with their historic law," she writes. But that just means less time to get things done. So, instead of testing for these glitches months ago, the testing phase is happening a week before launch.
Blamability: Medium-High. That was just so long ago and some of the people who passed the law aren't in office anymore. But, yeah, all along the tight deadline has been an issue for Health and Human Services, the government agency implementing the reform. "Much remains to be accomplished within a relatively short amount of time," said a Government Accountability Office report back in June. Throughout the process, the organization has had to delay testing. Of course, glitches are to be expected — that's what testing phases are for — but it looks particularly bad this close to launch.
Republicans: Republicans siphoned funds and institutional support, which delayed the process. McArdle says it herself:
Republicans who were enraged at the party-line vote and the procedural maneuvering repeated the smug brush-off they’d been given by the president: "Elections have consequences." They refused to help Democrats repair the gaping holes in the bill, or appropriate extra money for the rollout.
Blamability: Medium-High. That money argument only really applies to the federally-funded exchanges. As an incentive, the state run exchanges got unlimited funding to build their systems. Federal exchanges, however, had limited funds. So, on a federal level, if this is a money problem we can doubly blame the Republicans. Not only did they refuse to "appropriate extra money" but a majority of the federally-run exchanges are in Republican states, as you can see in the chart via Wonkblog at right.
The Federal Government: Or, more specifically, Health and Human Services, the bureaucracy in charge of implementing health care reform. Again, McArdle's they-don't-understand-tech-things argument works here.
Blamability: High. This organization works with all the separate actors above and therefore can be blamed for each and all problems.