Health Care Exchanges At The Six Month Mark

The enrollment period for Obamacare ostensibly ended on March 31. This would seem to be a good point at which to assess the government’s achievements in creating an online marketplace for health insurance. Whether Obamacare lives up to its extravagant promises for more, better and cheaper health care is an even bigger question, the answer to which will only be revealed over time.

On the specific issue of the government’s ability to create and manage the massive online health care enrollment system consisting of both the federal exchange and 33 state exchanges, the answer is, at best, a mixed one. Clearly, the rollout of HealthCare.gov was a disaster. Although government officials and news sources were quick to blame the private contractors for the problems, it became increasingly clear that most of the responsibility rested with the government officials themselves.

Some of the state exchanges have been even bigger disasters than the federal exchange. Maryland has become the poster child for failure. On the other hand, the Connecticut exchange has proven so successful at enrolling individuals that a number of states are looking to copy its approach or even contracting out to Connecticut to run all or parts of their exchanges.

None of the companies hired to build the federal or state exchanges were neophytes in this field. Most had extensive successful experience with complex government programs involving big software systems and online interfaces. The company originally tasked with building HealthCare.gov, CGI, works for some 100 federal agencies and 200 state and local governments. If they were able to make these other systems work well, it is hard to believe that they simply forgot how to do their jobs when it came to Obamacare.

In fact, in view of the shackles placed on the private contractors responsible for building the web site, it is remarkable that they accomplished so much. Remember that what the Obama Administration had asked for was unprecedented: a real-time, transaction-based system in government, comprised of 6 systems involving 55 contractors, 5 government agencies, 36 states, and more than 300 insurers with over 4,440 insurance plans.  The system that today has “signed up” over six million people, is basically the one that existed back on October 1, 2013. The fact that it works even with major glitches is a testament to the quality of the technology involved and to the effort made by the many private companies that sweated blood and continue to do so to make it happen.