President Obama's belated apology on Thursday for a key part of the Affordable Care Act's chaotic rollout suggests that his administration hasn't yet taken to heart the clearest lesson to emerge during the intense scrutiny of the law's launch.
Political considerations — mainly, fear of Republican criticism — trumped competence, transparency and about everything else as the administration worked to implement the historic law, according to congressional investigations and media coverage that has provided a troubling look at the behind-the-scenes decisionmaking. The president chose political appointees instead of technology experts to build the HealthCare.gov website and rolled it out prematurely. He also reportedly ignored staffers' concerns about making an ironclad guarantee when repeatedly making a promise he shouldn't have — that everyone who wanted to keep their health plan could do so. The monumental price now being paid: a HealthCare.gov website on technical life support and the understandable nationwide uproar over cancellation notices.
Obama will be tempted to put politics first again as he faces another critical decision about the ACA's future before year's end. Some of the nation's top information technology experts are now working feverishly to fix the website so that consumers can buy new plans by mid-December, the cutoff for coverage that begins Jan. 1.
The experts should be given a chance to get the site working. Calls to delay the individual mandate to buy health insurance, extend the enrollment period or make other accommodations are premature. But if HealthCare.gov isn't ready to go next month, Obama will likely have to accede to some of his fiercest critics' calls to delay the mandate or the financial penalties for those who don't buy insurance by March 31.
The health care marketplaces are a key part of the ACA. They're aimed at people without insurance and those who buy insurance on their own instead of getting it from an employer or through Medicare. Because Minnesota is one of 16 states to build its own online marketplace, consumers here can use the more reliable MNsure site to buy insurance and see if they qualify for tax credit assistance.
Republicans will undoubtedly use any kind of delay as a political club against Obama and congressional Democrats. That should be the least of the president's concerns. What he needs to do in the weeks ahead is rebuild the public's confidence in the law and those administering it.
If HealthCare.gov needs more time for repairs, he should be upfront about it and take the necessary steps to shield consumers from penalties for not buying coverage.
Obama's apology was another misstep. The president said he was sorry that people "are finding themselves" in a situation where their plans have been canceled "based on assurances they got from me." His carefully wordsmithed apology came across as an insincere attempt at damage control.
The policy cancellations, while troubling, do need to be put in context. Generally those at risk are in the individual market — about 6 percent nationally of those who buy health insurance. About half of them will see little change to their plans, according to Jonathan Gruber, an ACA architect and respected economist at the Massachusetts Institute of Technology.
The other half of the group — about 9 million Americans — will need to buy a new policy, and many will have to pay more for their coverage, Gruber estimated in a recent New Yorker article. While many will get improved coverage, the higher cost and the shock of getting a cancellation letter after the president's promises has understandably caused ire.
Media reports featuring angry consumers have fanned the flames. But follow-up reports have revealed that some disgruntled consumers are eligible for far better and less expensive plans. One Minnesota family featured in a recent news report about losing their current plan hadn't yet shopped on MNsure. Had they done so, they could have chosen from 66 plans with more extensive coverage and similar premiums and deductibles.
Listening to the cancellation uproar, it's tempting to think the individual market was insurance nirvana before now. It wasn't. Premiums in Minnesota increased nearly every year from 1999 to 2010, with some years seeing spikes of nearly 20 percent, according to state Health Department data. Annual deductibles also rose significantly in this time frame.
The ACA provides financial assistance and greater consumer protections, especially for those who are most vulnerable because of existing medical concerns. The old system had to change. A president who campaigned on "hope and change" needs to work far harder to convince the public that the changes underway are for the better.