Health care reform rollout is rocky but repairable

  • Article by: EDITORIAL BOARD , Star Tribune
  • Updated: October 19, 2013 - 3:09 PM

A past launch, Medicare Part D, offers a reason for optimism.

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Forms and a newspaper article were spread on a table as a representative of Marketplace Nebraska, a health insurance broker under the new Affordable Care Act, explained the health insurance enrollment process and the options that are available in Omaha, Neb., Tuesday, Oct. 1, 2013.

Photo: Associated Press, Nati Harnik

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It was a young president’s signature domestic policy achievement — a landmark law that created a new national health coverage program for millions of Americans.

But as the historic initiative rolled out, jarring problems emerged, raising doubts not only about its launch but about the fate of the program itself. Serious information technology glitches surfaced, a situation exacerbated by overwhelming demand for the new coverage, making it difficult for consumers to enroll and for private insurers and providers to retrieve information needed to deliver the new health benefits.

Confusion reigned as consumers tried to sort through new benefit plans and figure out their eligibility for financial assistance. Lawmakers raised strident concerns about the new program’s cost, about data security and about the competency of federal agencies administering it. As problems mounted, 37 states finally took matters into their own hands, setting up temporary programs to make sure new enrollees got promised benefits as problems were fixed at the federal level.

The litany of problems sounds familiar to anyone tracking the launch of the Affordable Care Act’s new online insurance marketplaces, which opened Oct. 1. But the problems described aren’t ripped from the headlines. Instead, they’re chronicled in a Georgetown University/Robert Wood Johnson Foundation report about a health care program that launched in 2005 — Medicare Part D, which was passed in 2003 in President George W. Bush’s first term and began enrolling senior citizens in outpatient prescription drug coverage two years later.

While Part D drug coverage had a difficult start, it’s now a valued part of Medicare and one often pointed to as an example of a federal government initiative that works. That’s why it’s important to take the long view of the ACA’s rocky rollout as problems pile up, particularly with the healthcare.gov insurance marketplace run by the federal government for states that opted not to build their own. Part D’s success after a troubled launch suggests the ACA marketplaces can and will get better, too.

Still, Minnesota made a smart decision to build its insurance marketplace. MNsure’s launch hasn’t been without turbulence, but it appears to have gone more smoothly than healthcare.gov.

Despite difficulties that would have been dubbed a “train wreck” in today’s bitterly partisan political environment, Part D’s problems were tackled and eventually ironed out. No one lost sight of the worthy goal of assisting seniors.

The ACA will provide potentially lifesaving health care coverage to millions of Americans, with the marketplaces the main way coverage and financial assistance is delivered. That noble goal shouldn’t be forgotten as members of Congress turn their focus to healthcare.gov after the shutdown/debt ceiling debacle.

The problems now occurring with healthcare.gov are disappointing, but shouldn’t come as a surprise given Medicare Part D’s difficulties. That’s not an excuse, however, for problems three weeks into operation. Kaiser Health News writer Phil Galewitz reported on Friday that he was finally able to create a healthcare.gov account after trying 63 times (in contrast, a Star Tribune editorial writer created a MNsure account in five minutes on the first try this week). Insurers are also reporting duplicate enrollments for those who are able to navigate the federal exchanges.

Whether someone should be fired for the federal websites’ problems, as some have called for, is unclear, but officials overseeing the healthcare.gov website should be held accountable and provide more reassurance that problems will be addressed quickly. Anti-Obamacare ideologues in Congress delving into these issues need to be cautious about calls for termination. Their own handling of the shutdown/debt ceiling standoff set a new standard for mismanagement.

Health care experts interviewed this week by an editorial writer are optimistic that officials can get critical healthcare.gov fixes in place by late next month — crucial timing, because consumers need to enroll by Dec. 15 to have coverage beginning in January. Enrollment also continues through March 31 for 2014 coverage.

MNsure officials deserve credit for avoiding key problems miring down healthcare.gov. The state planned for high website traffic during MNsure’s first month and had the information technology infrastructure to handle it. It also allowed people to comparison-shop for health plans on MNsure without first creating an account. Federal officials’ decision to do the opposite was a major error, because account creation glitches blocked consumer access.

There’s still considerable work to do to make healthcare.gov and MNsure deliver the best possible service to customers. Medicare Part D is a success because health care insurers and providers and a bipartisan array of federal and state policymakers came together to make it better. The ACA’s new marketplaces deserves the same teamwork, patience and support.

  • A prior example

    To read the Georgetown University/Robert Wood Johnson Foundation report on Medicare Part D’s troubled launch, go to http://tinyurl.com/nydc6ev.

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