The drip-drip-drip of health care malfunction

There's no alarm that goes off each time a would-be applicant to the Covered California program, or any of the other insurance exchanges, simply gives up trying to enroll in a health plan. But given the massive technical problems during the first 18 days the websites have been live, along with the limited number of applications received by insurance companies handling the claims, you can safely assume that lots of business is being lost - and it's also a good bet that many of the folks giving up are young, healthy, and not in desperate need of coverage. In other words, the same people whose premiums are supposed to help offset the cost of older, sicker policyholders. It's still possible that many of the problems can be resolved over the next few weeks; getting accurate information from real experts who know what they're talking about has been a challenge (not helped by the various political spins). But even now, disinterested observers have to wonder why it's come to this. NRO's Yuval Levin spoke to several officials at the Center for Medicare and Medicaid Services (the federal agency that runs the exchanges), and he offers what seems to be a good assessment of the situation.

The reaction of these individuals to what has happened in the last two weeks is the reaction of people who are coming to realize that their expectations and understanding of web development were mistaken. They believed (as I did too, I admit) that whatever technical problems the exchange sites encountered at first could be cleared up quickly and simply once things got going--that the contractors developing the websites could just respond to problems on the fly, as they became apparent. It is now increasingly obvious to them that this is simply not how things work, that building a website like this is a matter of exceedingly complex programming and not "design," and that the problems that plague the federal exchanges (and some state exchanges) are much more severe and fundamental than anything they imagined possible. That doesn't mean they can't be fixed, of course, and perhaps even fixed relatively quickly, but it means that at the very least the opening weeks (and quite possibly months) of the Obamacare exchanges will be very different from what either the administration or its critics expected.

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All of the CMS people I spoke with thought the state-run exchanges are in far better shape than the federal system under their purview. But the insurers do not seem that much happier with many of those state exchanges. Back-end data issues seem to be a problem everywhere, and some of the early enrollment figures being released by the states are not matching up with insurance company data about enrollments in those states, which suggests a breakdown in communication that is only beginning to be understood. The insurers believe that only Nevada, Colorado, Washington state, and Kentucky have what could reasonably be described as working systems at this point. Still, there is no question that on the whole the states with state-run exchanges are in better shape than those with federal ones.