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No way to run a health exchange

The new federally run health insurance exchanges have stumbled badly in trying to sign up customers online, stymied by both design flaws and inept execution. If the website's problems aren't solved soon, they could inflict a greater toll on the Affordable Care Act than the law's opponents have. There's some consolation in the fact that shoppers can sign up over the phone or in person, and that they can enroll as late as mid-December and still have coverage on Jan. 1. But the failures are mind-boggling and inexcusable, especially considering how much time the government had to prepare.

To make insurance affordable for low- and moderate-income Americans, the 2010 healthcare law provides subsidies for both premiums and co-pays. Those subsidies are available only through the new state exchanges, 36 of which are being run by the federal government. When the exchanges started signing up customers on Oct. 1, however, their websites buckled, unable to handle the unexpectedly large amount of traffic. Some state-run exchanges, like Kentucky's, rebounded right away. Others, such as California's, worked through their kinks more slowly and may still be missing key features.

The federally operated exchanges' website, HealthCare.gov, has experienced the most numerous, serious and enduring troubles. On the front end, users struggled just to register and log in so they could see what plans were available in their communities. Those problems linger, although they're becoming less of a roadblock. And on the back end, insurers say the site has been providing garbled or unreliable data about the customers who've signed up for their plans.

The administration exacerbated the problems by requiring people to register and determine their eligibility for subsidies before letting them browse through the offerings at HealthCare.gov. Critics say the administration was trying to mask how high premiums actually were by showing shoppers only the subsidized rates. Whatever the motive, it was a bad design choice that created a needless bottleneck.

Another issue was Washington's inability to get the site ready far enough in advance to test for problems thoroughly and make the necessary changes. The administration's allies argue that it was an enormously complex undertaking, and that vital work was delayed by legal challenges and congressional opposition. But those are just excuses. It was arrogant of administration officials to believe they could make the site work without extensive testing and a carefully staged rollout, as any other major website would require.

Happily for the public, the federal government has plenty of time left to address the problems. The site doesn't have to be perfect, it just has to deliver accurate information reliably to consumers and insurers in time for coverage to begin on Jan. 1. If it can't do even that within a few weeks, however, the administration may have no choice but to take it offline and stick to enrolling people by hand or by phone. The same goes for the state exchanges.

It's hard to gauge how consumers have been affected by the problems at HealthCare.gov because no enrollment data have been released yet. Regardless of the political consequences, the administration owes it to the public to be forthcoming about the site's performance, its problems and the progress toward solving them. The exchanges are crucial to the success of healthcare reform, and it would be tragic if they were derailed by the troubled online rollout.

Copyright © 2015, The Baltimore Sun
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