November 5, 2013; The Atlantic

 

It is kind of pathetic when you read article after article detailing shortcomings in the web portals for the Affordable Care Act. Reading Garance Franke-Ruta’s review of the problems signing up for Obamacare subsidies is distressing, in that a private site, eHealthInsurance.com, has volunteered to take over the “shopping and enrollment” process in the 36 states covered by the federal health insurance exchange while the federal government searches for fixes.

HHS has licensed eHealthInsurance.com as a partner in the implementation of the ACA, but Franke-Ruta notes that at least as of last Friday, its subsidy calculator was wrong, asking for taxable income rather than modified adjusted gross income to determine eligibility. She reports that eHealth put in a fix over the weekend, but says that it won’t work to solve all of the subsidy calculation problems.

She also says that the Kaiser Family Foundation’s subsidy calculator is also problematic, because it works poorly for self-employed people (contractors, freelancers, etc.), for whom the exchanges are very important. For readers who have ever had to file a Schedule C with their taxes, you know how confusing it might be to determine for ACA subsidy purposes what might constitute modified adjusted gross income. The situation might also be difficult for the state exchanges. New York’s exchange website, for example, is similarly troublesome for self-employed persons and, in an attempt to ask for information in plain English, mistakenly asks for taxable income rather than MAGI. In addition, New York’s self-employment income calculator asks for 2014 income information on a quarterly basis when applicants only have their 2013 income information to draw on.

Franke-Ruta doesn’t appear to be a critic of healthcare insurance reform, but her article, along with several others, is adding up to a tough assessment of the implementation of healthcare reform by the Obama administration. It cannot be dismissed as a website problem. In the structure of the Affordable Care Act, the website, whether healthcare.gov or the state exchanges, is the portal to the health insurance coverage that consumers need to use. For President Obama, the ACA is, at this stage in his second term, the most significant social policy legacy he has, comparable to Medicare in 1966 or even Social Security in 1935. While in hindsight President Obama and the nation would have been better served by a single-payer system, the ACA is a huge step forward in providing health insurance to the tens of millions who are underinsured and uninsured—but only if it gets past the terribly troubling rollout. The success of healthcare reform and the impression of federal government competence in the design and execution of important public initiatives hang in the balance.—Rick Cohen