President Barack Obama has few or no chances left to salvage health-care reform after major snafus with the federal exchange website and his erroneous comments that implied every person would be able to keep their health plan, no exceptions.
The federal exchange website has been a debacle, causing untold damage to the Affordable Care Act. Each day it clunks along increases doubts about the whole program. If Obama doesn't get the website fixed within weeks, he will be handing Republicans a campaign issue for 2014. If Republicans took both houses of Congress, they could attempt to repeal the ACA, leaving Obama severely weakened even if he vetoed such a bill.
Larry Levitt of the Kaiser Family Foundation told the Washington Post that "if the website had been working well, and a million people had gotten to the end of the process, we'd be looking at a very different trajectory now."
Levitt remains optimistic: "Assuming the website gets fixed, I would assume a surge of enrollment in December, and another surge in March."
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In full damage control, Obama has tried to thread the needle between his clearly wrong and oft-repeated promise that people could keep their health plans and the goal of having a large enough pool of people in the exchanges to spread risk and keep costs down. He announced Thursday that insurers could renew policies that do not meet ACA standards for another year, through the end of 2014 -- if states allow them to do so. This one-year extension will ease the disruption for some individuals, at some cost to the risk pool -- a necessary political step to restore a modicum of confidence.
His solution is better than the bill introduced by Sen. Mary Landrieu, D-La., supported by California Sen. Dianne Feinstein, to require insurance companies to renew old plans that don't meet minimum standards set by the ACA, if they were started in 2013 or earlier, unless the individual chooses another plan or the insurer stops providing health insurance in the individual market.
She expects that over time, people in the old plans would seek better value and more comprehensive coverage in the exchanges and the old plans would dry up. In the short term, however, healthier people who benefited from past insurer discrimination would most likely stick with their old plans, which means the risk pool in the exchanges could have fewer healthy people. Exchanges won't work if only sick people sign up. Senators should reject this indefinite, permanent solution.
What is completely unacceptable is a House Republican plan, introduced by Rep. Fred Upton, R-Mich., that would allow insurers to cancel plans, keep selling old plans that do not meet minimum standards under the ACA, enroll new people in these plans and deny coverage to people with pre-existing conditions. This really is repeal, and would mark a return to the bad old days.
The federal health exchange was supposed to be an opportunity for people to get health coverage in states where governors opposed the ACA.
In Texas, for example, Gov. Rick Perry refused to set up a state exchange where people can shop for health coverage and get subsidies, though his state has 6.1 million uninsured residents. Only 17 states, including California, set up their own exchanges.
According to the Department of Health and Human Services, the federal government in the first month processed applications for just under 1.5 million people. Of those, about 502,000 have actually selected a health plan or enrolled in Medicaid.
Most of these enrolled through a state exchange, like Covered California.
Clearly, the federal exchange website disaster continues to have ripple effects. The president and supporters of the ACA in Congress must do something.
But they must take great care in providing fixes, lest they unravel the whole program. The focus should be on doing whatever it takes to get the website and enrollments going.