Local conservative blogs and opinion sections seized on reports of initial technical glitches with the online health care exchanges to broadly slam the Affordable Care Act (ACA), and failed to recognize similar challenges with implementing Medicare Part D.
The online health care exchanges opened on October 1 to assist people in selecting an insurance provider in compliance with the ACA. Since the launch, several local opinion outlets have framed the story to maximize frustrations over technical glitches and paint the federal government as incompetent in preparing for enrollment. These same outlets have been repeatedly critical of the ACA.
For example, the Las Vegas Review-Journal ran an editorial that called the exchange launch "an information-technology disaster." Other outlets have been openly rooting for the exchanges to fail, such as North Carolina's Civitas Institute which called for readers to submit "Obamacare horror stor[ies]." Watchdog.org published a reporter's first-hand "maddening" experience with trying to log onto the New Mexico Health Insurance Exchange.
The user complaints are not completely unwarranted, as very real technical issues attributed to heavy traffic on the sites and software problems have been reported. High demand to access the health care exchanges drove 8.6 million unique victors to HealthCare.gov in the first 72 hours after the exchanges went live.
However, much of the negative local coverage of the rollout fails to take the exchanges in perspective. Few reports question whether it is reasonable to expect such a large and complex undertaking to run smoothly right out of the gate. The 2005 enrollment of millions of seniors in Medicare Part D - the government program to subsidize the cost of prescription drugs for Medicare patients - is the closest way to put the ACA exchanges in perspective.
Medicare Part D's rollout failed to meet its assigned start date by nearly a month, and still failed to prevent slow website loading and technical glitches during enrollment. The Georgetown University Health Policy Institute drew further comparisons between the ACA enrollment and Medicare Part D, concluding that even though Medicare Part D enrollment experienced initial glitches, the program remains popular today:
Even though there were problems this week, marketplace websites were at least up and running on the promised day, October 1. As reported by HHS officials, there were nearly 5 million visitors to healthcare.gov on the first day, far more than have ever visited Medicare.gov. During the 2005 signup period for Medicare Part D, the number of daily visitors to the online Plan Finder peaked at about 160,000 for a program that would enroll more people than are expected to enroll under the Affordable Care Act. By this standard, the level of interest in getting online information from the marketplaces is remarkable.
Seniors in 2005 were more likely to use the program's 1-800-Medicare call centers than the online resources, but the daily volume there never exceeded half a million callers. The call centers experienced both dropped calls and frustrating wait times to get through, especially in the first days and weeks.
Glitches continued with the Part D website and call center throughout the open enrollment period. But the program added both phone lines and customer service representatives and implemented other upgrades over the weeks. The website - both its functionality and the accuracy of its information - was the source of ongoing frustration for its users, but it did get better over time.
By the end of open enrollment in May 2006, over 16 million successfully enrolled for drug benefits in Part D (not counting another 6 million automatically enrolled as a result of participation in both Medicare and Medicaid). Initial glitches did not deter their enrollment. And today, Part D enjoys widespread popularity.
Negative coverage of the ACA exchange enrollment does not doom all of health care reform; similar negative coverage accompanied the start of Medicare Part D, a program that was less popular at its launch than the ACA before the exchanges opened. Furthermore, a separate Georgetown study titled "Launching the Medicare Part D Program: Lessons for the New Health Insurance Marketplaces" found that federal officials were able to troubleshoot issues and deliver on their policy promises:
Past efforts to design and launch a large national health coverage program suggest that the experience will be far from perfect, at least at the outset. However, the Medicare Part D experience teaches us that, when things went awry, federal and state officials were often able to identify problems and work with stakeholders to develop policy and operational solutions, so that consumers could obtain the promised benefits. Problems were not always addressed as quickly or as thoroughly as critics would have liked, but fixes were usually found.
Officials, policy-makers, and advocates preparing for the launch of exchanges in October 2013 face considerable challenges, not the least of which are constrained resources to support implementation and a highly polarized political atmosphere. However, there is much to be learned from the mistakes and the overall success of Part D. While flaws remain, a program born amidst partisan controversy and launched with considerable wariness has emerged to become a core part of Medicare.
There are signs the administration is actively taking steps to address concerns and fix technical issues with the exchanges. Online marketplaces were taken offline the weekend after the launch to perform maintenance and fix technical issues. According to The Guardian, repairs to the system have already produced improved results:
The latest figures provided by Health and Human Services Department reported a 50% reduction in wait times since Friday, following maintenance work over the weekend. Improvements included changes to the software to allow higher volumes, hardware changes and an increase in server capacity.
A statement issued on Monday by the Centers for Medicare and Medicaid Services stressed that the work was still taking place. "The work done to increase access to healthcare.gov, in light of the overwhelming demand, is beginning to show results. Call center wait times are seconds, not minutes, and people have been enrolling over the phone 24/7.
The conservative fight against expanding social programs is nothing new, however the current polarized state of politics has amplified the latest fight. Past critics of social programs have come to embrace them, most notably President Reagan who famously denounced Medicare before its implementation, only to expand the program as president. State and local conservative outlets should take note of this history and realize it is too soon to pass objective judgment on the ACA.