A reader writes:
There are a couple of counterpoints to your post you should mention.
First, this is now the fourth day of 180 during which people will be able to enroll. No one will even get coverage until January 1 of next year. Yes, the technical difficulties exist, but a relentless focus on them makes it seem like health reform isn’t working.
Second — and probably more important — the federal exchange was never intended to be anywhere near as large as it is. The ACA was designed so that states would run the exchanges, and they were given massive flexibility to make that happen. The intent was that the federal exchange would be a back up for a few states that could not, or would not take advantage of their state prerogatives.
Instead, a full 34 states decided they hated the federal government so much that they opted to let the feds run a health care exchange inside their borders.
This was clearly one of the choices they had, but no one anticipated that the sheer hysteria of health care reform would drive so many states to act so deeply against their own state interest.
So the federal exchange went from being a backstop to being the primary new program the federal government was required to operate. And the technical challenges of operating an exchange in 34 states with 34 hugely varying markets, populations, and state laws that needed to be accommodated proved to be enormous.
That is a very large part of the landscape HHS has had to deal with. Yes, the problems are real. But they are not immediately affecting anyone’s coverage, and they arise out of a political perversity it would have been hard for any rational person to predict.