Why a bad start does not doom Obamacare

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The first four weeks of the Affordable Care Act’s rollout have been ugly.

I spent Monday at Southside Medical Center in downtown Atlanta, a community health care clinic where nearly all of the employees and patients are black, and many openly praise President Obama. The patients, most of whom are uninsured, constantly ask center officials about signing up for “Obamacare,” which they have heard about through the media and are eager to benefit from. The center’s employees told me how most of the days over the last month have been disappointing, as they constantly have to tell patients to come back another time to try to enroll, because HealthCare.gov is down. A computer lab at the center, designed for patients to use to enroll in the new health care system after getting treatment, was empty on Monday, as the clinic employees didn’t feel confident enough that the website would work to send any patients there.

The current challenges of the Affordable Care Act are not just a media obsession. I’ve talked to strong Obama supporters with pre-existing conditions who are desperate to get health insurance and simply can’t get through the website process. The officials at Southside want to be able to log on to HealthCare.gov and scan through the health insurance options online directly with their patients, many of whom don’t have computers at home. They can’t do that right now, as the site nearly always locks them out at some point before they can finish the enrollment process.

At an Affordable Care Act event at a public library in Clarkston, an Atlanta suburb, later that Monday, co-sponsored by the pro-ACA group Enroll America, I watched as health care officials, also unable to use HealthCare.gov, went to a calculator on the website of the Kaiser Family Foundation that gives general estimates of how much people will pay for health insurance under the new law, quoted the unofficial rate using that site, which does not have any information about which health care companies or plans are operating in each state, and then handed people paper applications to mail in to formally enroll.

The federal government will tell them in a few weeks, via mail, what insurance options they are eligible for.

It was far from buying airline tickets on Kayak.com, as President Obama had suggested this process would resemble. And what President Obama promised, an easy-to-enroll system that would give benefits to many of the uninsured but not disrupt insurance for those who already have it, has instead turned into a bewildering experience for those without insurance and chaotic for some who are currently in health care plans that their insurance companies are now canceling.

But all is not lost for “Obamacare.” A complicated process for buying insurance is not a deal-breaker for the uninsured.  Many of them are old or have a pre-existing condition; buying health insurance before the rollout of the Affordable Care Act was often both complicated and extremely expensive, and the law addresses the latter if not the former. If mailing in a form instead of enrolling online ensures they will still get health insurance, they are fine with that outcome.

“I’m appreciative of my government,” said Mohamed Hussein, an Atlanta man who left the public library event after meeting with a health care adviser. Hussein, who works at a rental car service, did not formally enroll in health insurance, but was told he would get heavily subsidized insurance if he mailed in the ACA application form.

In addition, while Obama has spent little time speaking about the millions of Americans who are now eligible for Medicaid under the law, they are enrolling. The Advisory Board Company, a consulting firm tracking enrollment under the law, estimates that more than 115,000 Americans now have health insurance who didn’t before, including more than 80,000 now on Medicaid.

The biggest worry, even from some Democrats who back the health insurance law, is that the website problems will turn off young people, who will then not enroll in the new health care options. Without younger, healthier customers, insurance companies could next year opt to raise prices if they believe only people who are elderly or have illnesses are likely to enroll under the health care law.  Insurance could eventually become unaffordable for people who need it most, like the pre-ACA system.

That could happen, but it’s not a forgone conclusion simply because of the bumpy Obamacare rollout.

Jonathan Gruber, the Massachusetts Institute of Technology professor who helped design the Massachusetts law that the Affordable Care Act was based on and later served as informal adviser to the health care team for the Obama administration, says that young, healthy people are likely to enroll close to the deadline for getting insurance or being forced to pay a penalty under that law. That date is March 31 of next year. Obsessing over the number of people who enroll in the healthcare options in November or December, Gruber argued in a conference call set up by White House officials on Tuesday, is not that useful.

“The fact that people aren’t signed up now is not at all interesting or important,” Gruber said. “The success of health care reform has to be measured in months and years, not days and weeks.”