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Today my editor Joe Weisenthal asked me how long the administration realistically has to fix the Obamacare website.
Unfortunately, there's no exact answer to that question.
The question is kind of like "when does the debt ceiling have to be increased?"
Every day the debt ceiling wasn't raised, uncertainty over the government's finances did more damage to the economy. But the government would not have actually run out of money if we had gone past the widely-discussed Oct. 17 deadline. The actual drop-dead date was days or weeks later, and nobody could predict in advance the exact deadline.
Similarly, it would be good if Healthcare.gov were in good working order as soon as possible. The longer the website problems drag on, the more problems will be created in health insurance markets and the more damage the site's problems will do to the law. Still it may be possible for the law to have a broadly successful implementation even if the site takes months to fully fix.
Healthcare.gov is not the only way to sign up for health insurance. 14 states have set up their own exchanges, which have shown varying performance that is generally much better than the federal website. For the other 36 states, the Administration notes that the federal website is sometimes working for some people, and there are alternative signup channels: in person, by phone, and by mail. But they have yet to make clear that they have the capacity to process millions of phone and paper applications, since the website was meant to be the primary signup vehicle.
The longer a broken website makes enrollment difficult, the bigger the problems that will be created for the overall program. The Obama Administration has set a target of 7 million signups for health insurance through Obamacare's exchanges by the end of March 2014. If many fewer people actually sign up, that could cause problems for health insurance markets for years to come.
That's because the more difficult enrollment is, the more likely the participant pool is to be (1) small and (2) disproportionately sick. That would mean fewer people getting useful coverage, and it could also mean a "death spiral" where premiums rise rapidly because insurers expect to be covering people with lots of medical needs.
Here are some key dates when problems will arise if the signup process is still not smooth:
- December 15, 2013. This is the last day to sign up for insurance and get coverage that starts by January 1, 2014. This is a key date for the 14 million Americans who are already insured through the individual market and want to maintain their coverage. These people can continue to buy coverage outside the exchange, but many are seeing premium increases because of how the ACA changes insurance markets and insurance plan structures. Many are also becoming eligible for premium subsidies they can only access by buying in the exchanges. If signup remains extremely difficult in mid-December (or even close to it, since people will need some lead time before the deadline to sign up) some Americans will end up paying more than they should or facing a coverage gap.
- February 15, 2014. If you're uninsured, this is the last day to sign up for an exchange health plan and get covered by March 1, and therefore avoid paying a penalty for having too long an insurance coverage gap. The Administration has been signalling that it is likely to use a hardship provision in the ACA to delay the individual mandate penalty if Healthcare.gov problems have persisted close to this date.
- March 31, 2014. This is supposed to be last day of enrollment for 2014 health plans. But enrollment may be extended if signup problems persist. Sen. Jeanne Shaheen (D-N.H.) is already calling for an extension.
- October 15, 2014. This is the day enrollment in the ACA exchanges will start for 2015 health plans. This will be a key date for "death spiral" concerns. If the 2014 participant pool was small and disproportionately sick, insurers may be inclined to raise premiums for 2015. They may be able to resist that urge if they know the website is working well, enrollment has gotten easier, and young healthy people who held off in 2014 are likely to buy.
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