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 Until now, the main damage from the website's technology woes has
been to Obama's poll ratings. But if it chokes again, it will be
everyday people feeling the consequences.
Some of those at risk are among the more than 4 million consumers
whose individual policies have been canceled because the coverage
didn't comply with requirements of the new health care law. A
smaller number, several hundred thousand, are in federal and state
programs for people whose health problems already were a barrier to
getting private insurance before the overhaul.
"The chances are almost 100 percent that someone who would like to
continue coverage next year and intends to secure it is not going to
be able to do it," said Mark McClellan, who oversaw the rollout of
the Medicare prescription drug benefit under President George W.
Bush.
"It's important to recognize that none of these programs are going
to work perfectly from the start and a big part of implementation is
having mechanisms in place that anticipate problems and help
mitigate their effects," added McClellan, now a health care policy
expert with the Brookings Institution think tank in Washington.
But on Monday, administration officials projected renewed confidence
that they're on top of things. White House spokesman Jay Carney
declared that the federal site serving 36 states got 375,000
visitors by noon.
Even as fixes continued on back-end features of the system,
enrollment counselors said the consumer-facing front end was working
noticeably better — but still was not free of glitches or delays. As
Carney acknowledged, some of Monday morning's visitors were shuttled
into a queue and advised when to return for speedier service. That's
actually an improvement to handle high volume, he said.
In the central Illinois city of Mattoon, enrollment counselor
Valerie Spencer said she and her team finally signed up their first
person in the days leading up to Thanksgiving. Now they have a
half-dozen success stories and dozens of consumers with appointments
to finish applications at the Sarah Bush Lincoln Center, a small
hospital serving the region.
The health care law offers subsidized private insurance to middle
class people who don't have access to job-based coverage. The White
House is aiming for 7 million people to enroll for private plans
through new state-based marketplaces also called exchanges.
Low-income people will be steered to an expanded version of Medicaid
in states accepting it. People have until Dec. 23 to sign up for
coverage that starts on Jan. 1.
"It's crunch time and a lot of people are really nervous," Spencer
said.
An even bigger enrollment surge is expected the first part of next
year, ahead of a March 31 deadline to avoid the law's tax penalties
for those who remain uninsured.
In Beverly Hills, Fla., north of Tampa, self-employed real estate
appraiser Tom Woolford said he was finally able to get all the way
through the process Sunday and enroll in a Blue Cross Blue Shield
plan. Except nothing happened when he clicked a link to pay his
first month's premium.
"As far as I know, I am in orbit someplace and nobody's got a
transponder on me," said Woolford, who was otherwise pleased with
the plan and his costs. He'll give it a week and see if the health
plan reaches out to him.
If consumers still have unresolved issues, so do the feds. Among
them:
THE BACK ROOM
Private insurers complain that much of the enrollment information
they've gotten on individual consumers is practically useless. It is
corrupted by errors, duplication or garbles. Efforts to fix
underlying problems are underway, but the industry isn't happy with
the progress and is growing increasingly concerned.
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Over the weekend, as government officials trumpeted improvements to
the website, the leading industry trade group pointedly called
attention to the data mess. The president of the largest health
insurance trade group said the website fix won't be complete until
the entire system works from end to end. Karen Ignagni, president of
America's Health Insurance Plans, raised the prospect that consumers
might not be able to get access to needed benefits Jan. 1.
"There really needs to be an intense focus now on the back end of
the process," said Joel Ario, who oversaw initial planning for the
insurance marketplaces in the Obama administration and is now a top
consultant with Manatt Health Solutions.
Administration spokeswoman Julie Bataille said that's already
happening. More than 80 percent of insurers' problems were due to
one bug that affected Social Security numbers, she said. That's been
fixed.
CRAFTING A NEW PITCH
Largely because of the federal website problems, major advertising
campaigns encouraging everyone from the young and hip to the middle
aged and health conscious to enroll have been put on hold.
The worry now is that the technology debacle may have done lasting
harm to the outreach plan. And even a revamped website with new
bells and whistles is going to have to compete for attention with
the year-end holidays.
"The real question in my mind is can they turn around the
messaging?" said Caroline Pearson, who is tracking the overhaul for
Avalere Health, a market analysis firm. "They've had eight weeks of
terrible press. Can they begin to reach out with a message of things
are fixed and we're back on track?"
It's unclear how much candor will creep into the pitch. Some
enrollment counselors feel a need to acknowledge the problems.
Looking back on the weeks of failed attempts to enroll people
through the marketplace, Spencer, in central Illinois, laments the
feelings of broken trust.
"We told them we were here to help them and we (couldn't) help
them," she said.
Still, some people returned again and again to keep trying to get
through the process. "They keep trusting us and they keep coming
back," Spencer said.
President Obama will focus on the broader benefits of the health
care plan Tuesday at a White House event where he'll be flanked by
people the administration says have been helped by the law. He'll
also take aim at Republicans, arguing the GOP is trying to strip
away those benefits without presenting an alternative.
[Associated
Press; RICARDO ALONSO-ZALDIVAR]
Associated Press writers
Carla K. Johnson in Chicago and Marco Mulcahy in New York
contributed to this report.
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