So it\u2019s been a month since the rollout of the health insurance exchanges created by the ACA, and it hasn\u2019t exactly been a fantastic rollout. It also isn\u2019t that unexpected, nor is it the worst rollout of all time. It certainly doesn\u2019t mean that Obamacare is doomed to failure. But there are a lot of lessons to be learned from this.<\/p>\n
<\/p>\n
There have been two major issues during the rollout. The first obviously is the condition of the website. The second has been the \u201ccancellation notices\u201d that many people have been sent about their non-compliant health care plans. For the latter, this is one of those times when you can truly say that it\u2019s not a bug, it\u2019s a feature. I\u2019ve been a bit shocked about all the attention that this issue has received, because it was known all along that Obamacare would require policies to meet certain minimum guidelines, and a lot of existing policies would not. The policies that people are losing are being replaced by policies that cover more items, and often for lower cost<\/a>. True, some people who had catastrophic plans will find that they can\u2019t find a plan that\u2019s as cheap, even without subsidies, and there are millions of people out there who will be in that situation<\/a>. Again, though, this isn\u2019t news to people who have been following the law.<\/p>\n Of course, this issue has come up because Obama repeatedly said that people who liked their insurance could keep it. He was largely referring to those with employer-provided health care, but he should have certainly had a clearer message for those who had catastrophic plans on the individual market. Something along the lines of \u201cIf you currently have a catastrophic plan, it will go away. But it will be replaced with a more comprehensive plan that will probably be cheaper.\u201d That would have been totally accurate, and may have blunted the complaints today.<\/p>\n The \u201cno major changes\u201d philosophy of Obamacare was deliberate, and small-c conservative. I have never liked it<\/a>, but given the realizations of the past month, it\u2019s probably a good thing that the law was rolled out this way. If employer-based healthcare were dropped entirely and the exchange didn\u2019t work, this truly would have been a catastrophe. So far, it is incredibly bad that people aren\u2019t having success on the federal exchange (state exchanges are another matter<\/a>), but it is the minority of the country that even has to deal with the exchanges. It\u2019s good that the initial implementation was incremental, as much as I don\u2019t like it.<\/p>\n Let\u2019s talk about the federal exchange. First, because of the way it was designed, setting up this exchange is probably one of the biggest IT projects that the government has ever done. It\u2019s not the website itself that\u2019s the problem, it\u2019s all the systems the website has to talk to<\/a>. Project this big are not easy to pull off. Even the private sector has had a lot of failures in this realm. It happens.<\/p>\n Not that there weren\u2019t ways to improve the odds of success. With such a huge project, you need a good PM who has seen these kinds of things to completion before. The Obama administration dropped the ball on that point<\/a>. They have had a tendency to be wonks who think they can do things quite well on their own; that was not the case for the exchange project. Ideology or hubris? Probably the latter, although who knows.<\/p>\n One criticism that I don\u2019t think is fair is that the government used outdated development techniques<\/a> on this project. Yes, Agile is great for a lot of things. It would have been disastrous for Obamacare. Agile works when you can incrementally add features to a product, all the while providing at least some level of functionality. The exchange simply would not have worked if all the pieces hadn\u2019t been in place, and so a Waterfall methodology made a lot more sense. There are plenty of places that the government could use Agile development, but I don\u2019t see how this was one of them.<\/p>\n The biggest problem that the exchange faced is that it is needlessly complex<\/a> due to the politics surrounding the law\u2019s passage. The reason all those back-end systems need to talk to each other is because the law has a very complex system of subsidies, income requirements, and eligibility requirements. The sausage factory that produced this law made it so, but it didn\u2019t have to be this way. I do hope that in the long term, all of this goes away, and in concert with the end of employer-based insurance, we have a system where there are no subsidies or eligibility requirements. Instead, everybody can sign up for a Silver plan with no out-of-pocket premium expense. If you don\u2019t sign up, you are randomly assigned to one. Sign up for a Bronze plan, get money back. Sign up for Gold or Platinum, pay some additional premiums. That\u2019s it. You pay for it through the tax code, and then subsidies to insurance companies themselves based on who signs up for their plans. Other countries do it in much this way, so can we.<\/p>\n In the meantime though, we have to deal with the system we have. I don\u2019t think any of the technical issues of the exchanges are things that can\u2019t be overcome, but they need to be fixed soon or the long-term changes that the program needs to become better are in jeopardy. Getting things working well enough to declare success is probably the biggest lesson that the Obama administration needs to learn before the end of this month.<\/p>\n","protected":false},"excerpt":{"rendered":" So it\u2019s been a month since the rollout of the health insurance exchanges created by the ACA, and it hasn\u2019t exactly been a fantastic rollout. It also isn\u2019t that unexpected, nor is it the worst rollout of all time. It certainly doesn\u2019t mean that Obamacare is doomed to failure. But there are a lot of… Continue reading Rollout<\/span><\/a><\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"closed","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"om_disable_all_campaigns":false,"_monsterinsights_skip_tracking":false,"_monsterinsights_sitenote_active":false,"_monsterinsights_sitenote_note":"","_monsterinsights_sitenote_category":0,"footnotes":""},"categories":[4],"tags":[77],"class_list":["post-969","post","type-post","status-publish","format-standard","hentry","category-politics","tag-health-care","entry"],"aioseo_notices":[],"_links":{"self":[{"href":"https:\/\/www.nathanhunstad.com\/blog\/wp-json\/wp\/v2\/posts\/969","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.nathanhunstad.com\/blog\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.nathanhunstad.com\/blog\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.nathanhunstad.com\/blog\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.nathanhunstad.com\/blog\/wp-json\/wp\/v2\/comments?post=969"}],"version-history":[{"count":2,"href":"https:\/\/www.nathanhunstad.com\/blog\/wp-json\/wp\/v2\/posts\/969\/revisions"}],"predecessor-version":[{"id":972,"href":"https:\/\/www.nathanhunstad.com\/blog\/wp-json\/wp\/v2\/posts\/969\/revisions\/972"}],"wp:attachment":[{"href":"https:\/\/www.nathanhunstad.com\/blog\/wp-json\/wp\/v2\/media?parent=969"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.nathanhunstad.com\/blog\/wp-json\/wp\/v2\/categories?post=969"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.nathanhunstad.com\/blog\/wp-json\/wp\/v2\/tags?post=969"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}