Thursday, October 24, 2013

Catching up with the healthcare.gov snafu

Much of this fits with 2305's coverage of the executive branch and its role in implementing the law. Here's the first of a few links to stories that relate to subject matter we've either covered, or will get to soon.

It takes you to an overview of the problems so far complied by Wonkblog's Sarah Kliff.

The snafu in question is the problem the federal government is having getting its health insurance exchange - which is meant to help the currently uninsured get insurance - up and running. In the 16 week 2305 classes we've been discussing the expanding role of the federal government, and creating exchanges for purchasing health insurance - for those who cannot afford it at the prices commanded in the existing marketplace - is an example. As far I know, the federal government has never done anything like this before. Some services - like Social Security and Medicare - are provided by the national government directly - so there is no need to create an exchange which allows people to purchase the service from a private provider. Others - like Medicaid - are funded by the national government, but run by the states.  

Kliff points out which states have opted to create their own exchanges and which have not.





The exchanges created in many of the states have apparently been working well - New York's for example.

Some aren't doing quite as well:


What about states running their own marketplaces? Are they doing any better?

It depends a bit on the state. A few, like Kentucky and Connecticut, have been able to enroll people pretty seamlessly. They credit this to extensive testing prior to launch and realistic expectations. Connecticut, for example, scaled back its workload about a year ago, deciding to focus on getting the really important pieces of the marketplace ready to launch on day one.

Other states have...had some trouble. Hawaii’s Web site only launched last Tuesday, two weeks after it was meant to go live. Oregon has signed up lots of people for Medicaid -- but technical issues have prevented their exchange, Cover Oregon, from enrolling anyone into private insurance coverage.

Note that Texas chose to not create its own exchange. This was a contentious topic in the 83rd session of the legislature earlier this year. People who want to purchase this insurance in Texas have to go to the national exchange - here's a report that Governor Perry wants Texans to sign up through the federal exchange. When we discussed federalism - in both 2305 and 2306 - we discussed the pros and cons of allowing state discretion in the implementation of public policies - this might be a further argument in favor of state implementation of laws.