Health IT

Let them speak! Obama missed golden opportunity to kill ACA urban legend

President Obama and the administration could have proved that there are real live people who have successfully purchased a health insurance policy through healthcare.gov. As he always does, the President had a lovely backdrop of smiling people standing behind him today when he spoke for the first time about the launch of the health insurance […]

President Obama and the administration could have proved that there are real live people who have successfully purchased a health insurance policy through healthcare.gov. As he always does, the President had a lovely backdrop of smiling people standing behind him today when he spoke for the first time about the launch of the health insurance exchanges.

The session opened with a small business owner from Delaware who got insurance through the federal exchange. She said she was not old enough for Medicare but old enough to have a few health problems. Obama later said that previously the woman had been turned down for coverage three times due to pre-existing conditions. So, hooray for that one woman from Delaware.

That was it. We didn’t hear from any of the other citizens at the podium. This was the perfect time to show the press and the ACA-haters that healthcare.gov works – a little bit – sometimes – for a few people.

Obviously it wasn’t appropriate for reporters to ask these people detailed health questions, but surely they could have added some context to the conversation. Did they all get coverage from healthcare.gov? How will it change their current coverage? What’s the worst part about the web site? Obama framed the web site in shopping terms: “I want the cash registers to work and check out to be smooth so people can get this great product.” He had a crowd of customers, but we didn’t get to hear from any of them. Hearing from any one or two of those people would have been a great antidote to the confused college student and the rest of the “it’s not really working” theme from the first weeks of the launch of healthcare.gov.

Instead of having these people speak, the president read letters he had received from other Americans about the ACA. One mom mentioned coverage for her son with Aspergers and a dad said he was going to save $900 a month thanks to his new exchange policy.

Obama gets a couple bonus points for recognizing reality by quoting a letter that said, “Yes, the web site really stank for the first week.” But other than that the press conference was disappointing.

Obama’s remarks were all ACA 101 – did you know preventative services are covered now? Did you know that you can’t be denied coverage if you have a pre-existing condition?

YES, we know that! Tell us more about how you’re going to fix it. Vague comments about the hordes of tech volunteers who want to help is not enough. Alex Howard wrote an excellent analysis of the epic failure of healthcare.gov, and has this to say about why more smart technologists didn’t get involved in the first place:

The sad truth is that unless we reform how government buys, builds, and maintains information technology, we will continue to get more Healthcare.govs. They’ll be built at regulatory agencies, scientific agencies, or places like HUD or the Department of Education or nameless federal agencies that most people don’t know exist, along with higher-profile ailing IT projects at the Department of State. Federal IT may be too big to succeed.

It was no accident that HHS Secretary Kathleen Sebelius was sitting in the audience – and looking unhappy based on the quick pan of the front row of chairs. This insured that there would be no substantial discussion of the state of healthcare.gov or its prospects for improvement.

He even recited the 1-800 number for the federal exchange and reminded people they could sign up for insurance in person also. Maybe the old-fashioned ways will save the ACA and healthcare.gov. Although the New York Times reports that “Several calls to the number immediately after he read it produced busy signals.”

The other missed opportunity – mentioning the states
“See? You should have done it yourself!” This could have been directed at the 34 governors who chose not to build their own insurance exchange. There has been nothing but good news about kynect KY – Kentucky’s exchange. California also has launched a successful site as well.
Obama could have said, “It’s working in Kentucky, California and Colorado.”

This point only goes so far, however, because several states – Hawaii and Oregon among them – still don’t have functioning web sites. However, states that decided to own this part of the ACA are doing far better than the federal exchange.

A small bright spot
“We did not wage this long and contentious battle to run a web site.” The only tiny saving grace so far for healthcare.gov and the ACA is that this first enrollment period is 6 months long. Obama is right that we are only three weeks in. He closed his comments with this reminder to start reframing the issue. The ACA has helped some people so far, but it has a long way to go to be a success.