Let's get serious. The insurance exchanges are still not ready for prime time. This is not simply a matter of failing to test computer systems or tracking down a few bugs in the software.
The website crashed because the administration did not understand how consumers think. Most people like to kick the tires before they buy the car. They want to look at their health plan options without having to give their names or any other personal information.
HealthCare.gov does not permit anonymous browsing because the administration did not want consumers to be scared away by high insurance premiums. The website is designed to fully verify whether a consumer is eligible for a subsidy, and if so, how much it will be. The cumbersome verification process, which is not necessary to give individuals a good idea what their premium is likely to be, caused the traffic jam.
The health insurance exchanges could not deliver the easy online shopping experience that many expected. That will not change, even with a great deal more work and money spent patching up the computer systems. The problem is more fundamental. The ACA created an extraordinarily complex set of subsidies and rules, and no amount of computer programming can cut through the resulting confusion and inefficiency imposed on the health sector.
Other disappointments await those who are counting on the ACA to solve their health insurance problems. Millions of people who previously could not buy insurance because of pre-existing conditions are now able to do so. But they are likely to find that the coverage they want is very expensive.
That's because the subsidy, which cuts the premium to $55 a month for someone with an annual income of $17,000, is tied to the second-lowest cost “silver” plan. Such a plan generally has a narrow provider network and a substantial deductible that must be paid before insurance kicks in.
Better plans cost more, and the consumer is responsible for the full difference in cost. In New York, that $55 monthly premium can easily triple just to enroll in an average-cost silver plan.
A fixed subsidy that does not increase for more expensive health plans creates strong incentives for plans to offer better coverage at lower cost. If you are trying to promote efficiency in healthcare delivery, it's an effective tool. Nonetheless, it invariably draws hostile fire when Republicans (who call it premium support) propose it for Medicare.
The ACA's primary goal is to expand health insurance to the 15% of Americans without coverage. But it has serious consequences for the rest of us who already have coverage and would like to keep it.