Healthcare.gov mostly works for consumers now. Next it needs to work for insurers. And then it needs healthy people to sign up.
Obamacare is more than just a website, but the website is critical. And now, after its glitch-filled debut, Healthcare.gov is working better. But is it working well enough that the law itself will work?
At this point, we know two things about Obamacare. First, the federal website couldn’t have been much more of a train wreck to start. And second, the law works when the website works, like it does in California and Kentucky. Those states set up their own online exchanges, so their enrollment hasn’t been held hostage by Healthcare.gov’s myriad technical difficulties. And they were myriad. As my colleague Garance Franke-Ruta points out, the administration’s latest progress report shows us just how bad things were back in October. When it launched, Healthcare.gov was only up about 43 percent of the time. Today, it’s up about 90 percent of the time (excluding scheduled maintenance).
But this isn’t anywhere near mission accomplished. As Philip Klein points out, 90 percent up-time is still catastrophically bad by private sector standards. How catastrophic? Well, consider that in 2012 the lowest up-time for any of the top 130 retail websites was 99.34 percent. So there are clearly more bugs to work out.
But Healthcare.gov does have one advantage over, say, Amazon. People don’t have to buy books. They do have to buy health insurance—and might even get a subsidy to do so. Now, that doesn’t mean a 90 percent up-time is acceptable. Just that it’s workable, because people will be more patient when they have to buy a product. Indeed, plenty of people were still having trouble logging on to Healthcare.gov on Monday, but plenty more were finally able to get through. And many more than that will continue getting through over the next few months.
In other words, we’ve moved on from asking whether anyone will even be able to sign up for Obamacare. Now the concern is whether people will actually get the plans they sign up for. At least that’s the insurance companies’ concern. The administration has fixed most of Healthcare.gov’s front-end problems, so people can pick a plan. But it hasn’t fixed all of the back-end problems, so insurers can know who has picked what plan. That customer data isn’t always getting through.
If the last month has taught us anything, it’s that the administration will probably jury-rig some kind of back-end fix that’s just good enough to work. If that happens, we’ll graduate one more time from asking whether technical problems will sink Obamacare. Then the concern will be whether design problems will sink it. In other words, whether enough healthy people will buy insurance to keep premiums from spiraling up and up. And we probably won’t know that until open enrollment ends in March, since healthier people tend to procrastinate when it comes to buying coverage.
But for now, at least, Obamacare lives.