Higher-than-expected volume, technical glitches, insufficient funding from Congress, HHS' late release of important regulations, and fierce political opposition to the Patient Protection and Affordable Care Act from congressional and state Republicans all have been cited as reasons for the terrible start. HHS has provided no enrollment figures yet, and a spokesperson said the department plans to release monthly updates, likely starting in the middle of November. States generally will release their figures on a monthly basis also, the spokesperson said.
No one knows how long it will take HHS, which is fully or partly running the exchanges in 36 states, to ease the way for people to shop and sign up for coverage on the online federal marketplace, HealthCare.gov. Some experts say the system can be tweaked to work satisfactorily, particularly as traffic drops off from its heavy initial level. But others say it may need a total overhaul. Meanwhile, some but not all of the 15 state-run exchanges have fared better, reporting that nearly 50,000 people had signed up for a plan by the middle of last week.
Chip Kahn, president and CEO of the Federation of American Hospitals, said the federal exchange will lose a lot of potential enrollees if it doesn't fix the problems fast. He said the Obama administration's goal of signing up 7 million uninsured Americans in 2014 “doesn't look possible” at this point.
And there are signs that things could get worse before they get better for the federal marketplace, though there have been recent signs of improvement in the federal website's functionality. Late last week, reports surfaced that insurers were having trouble processing new enrollees because they are getting inaccurate, incomplete or duplicate data from HHS.
Joanne Peters, an HHS spokeswoman, said “we know that people are enrolling in coverage and the system works. As individual problems are raised by insurers, we work aggressively to address them.”
Difficulties with the federal website could dampen enrollment, and a lower-than-expected enrollment could drive up the premiums exchange health plans set for 2015, said Christopher Condeluci, an attorney at the law firm Venable who worked with Republicans on the Senate Finance Committee when the ACA was drafted.
There are high political stakes in getting the insurance exchanges to work well. The success or failure of the Affordable Care Act exchanges will hang heavy over the 2014 election cycle. Henry Aaron, a senior fellow at the Brookings Institution who specializes in healthcare financing, said the rollout of the Affordable Care Act is likely to be the biggest domestic political issue next year.
If HHS is unable to make the system run more successfully by Jan. 1, that could give congressional Republicans powerful ammunition for delaying the law's individual mandate for nearly all Americans to get coverage, said Tom Miller, a resident fellow at the American Enterprise Institute. “If you can't enroll people, how can you penalize them?” Miller said, adding that Democrats “don't want to look down that gun barrel.”
On the other hand, voters could have a short-term memory about the troubled launch of the federal exchange if it's fixed soon, according to the FAH's Kahn. Miller said much will depend on what sticks in the public's mind—Republicans' role in shutting down the government, or consumers not being able to enroll successfully.
The disastrous rollout has prompted sharp criticism of HHS leadership and of HHS' information technology contractors. Robert Gibbs, President Barack Obama's former press secretary, said top officials should be fired, while Sen. Pat Roberts (R-Kan.) called on Sebelius to resign. Last week, White House press secretary Jay Carney said Sebelius has the “full confidence of the president.”
But later in the week, Carney acknowledged that the mistakes have caused headaches for consumers. “People have been working 24-7 to resolve (the issues) and make the consumer experience better,” Carney said. “Nobody is more insistent that that work be done and the experience be improved than the president.”