A Way Forward For The ACA?

Nov 20 2013 @ 12:16pm

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The good news for the president is that support for the law has not collapsed, especially given the massive – and largely deserved – shellacking of the wobbly website. A new United Technologies/National Journal poll makes for fascinating reading:

Amid all of the turmoil surrounding the law, solid majorities of Americans continue to say they believe it will “make things better” for people who do not have health insurance (63 percent) and the poor (59 percent). Only about one-third thought the law would “make things … worse” for each group. In each case, that’s a slight improvement in the overall judgment since the July poll. Back then, 58 percent thought the law would help the uninsured and 55 percent believed it would benefit the poor.

My italics. And there’s a distinct racial imbalance here. 58 percent of non-whites say the law will benefit the country overall, while only 35 percent of whites believe that. The danger for the administration is that many whites therefore see this as a transfer of wealth to nonwhites and away from them. But given our shifting demographics, that’s also a danger for Republicans.

Just as striking to me is the finding that support for repeal of the law has not grown, even as frustration has mounted: in July support for repeal was at 36 percent and is now at 38 percent. Those preferring to “Wait and see how things go before making any changes” numbered 30 percent in July and now is at 35 percent. 23 percent backed a third option: “providing more money so the law is implemented effectively.” That amounts to a 58 percent majority for keeping the law and trying to make it work. That strikes me as an important corrective to some of the hysteria in the Beltway.

I think all this comes from the realization that the status quo ante was a nightmare, and that it’s still early days for the ACA. Which is, again, a warning to the GOP: repeal is not going to win any converts unless you have a viable alternative that tackles some of the core problems, i.e. the millions of uninsured, the grotesque inefficiency of the American private healthcare sector, and the bar on getting insurance for people with pre-existing conditions and the maddening unreliability of any private insurance plan.

Add to this the tantalizing possibility that the federal website may soon be obsolete. Why? Because you can already get a lot of critical info from other sites like eHealth and the administration is now prepared to delegate the subsidy application process to insurers and online brokers. Andrew Sprung makes the case:

As of now, eHealth will give you price quotes incorporating your estimated subsidy, based simply on the single number you provide for your household income. It will also hold information for any plan you select and notify you when enrollment is available on eHealth — that is, when the site can initiate the subsidy application.

If you want to eliminate the middleman, once the government allows third parties to process the subsidy application, you can use a non-transactional comparison site like ValuePenguin and apply directly through the insurer offering the plan you choose. Many (I suspect most) insurers on the exchanges provide plan summaries online and enable online applications.

Once the government does outsource the subsidy application process — if eHealth and other online brokers can handle the traffic — someone please tell me: who needs HealthCare.gov? Its front end, that is, which always should have been easy. All that really matters is the back end: whether an application can be processed accurately in reasonable time. Perhaps the insurers and brokers will be able to expedite the process on behalf of their prospective customers. If insurers and brokers can take the complete application, all the government needs to do is refer users to functioning online brokers and the informational sites.

This seems to me to be a very pragmatic way to get around much of the site’s (and the ACA’s) start-up problems. But maybe I’m being too optimistic here. What am I missing?