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ObamaCare's worst-case scenario
The "tech surge" better work, and soon, or things could get really bad for the Affordable Care Act
The group that could keep costs low — young, healthy Americans — is the same group that may give up first on a glitchy website.
The group that could keep costs low — young, healthy Americans — is the same group that may give up first on a glitchy website. (AP Photo/Carla K. Johnson)
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t's hard to find anyone of any political stripe defending the rollout of ObamaCare, which has been plagued by massive glitches as people try (and usually fail) to sign up for health insurance through HealthCare.gov.

President Barack Obama conceded on Monday that the website "hasn't worked as smoothly as it was supposed to work." Progressive pundits have taken a harsher tone: The Washington Post's Ezra Klein calls it a "failure" while New York's Jonathan Cait brands the website "an unmitigated fiasco."

Still, unlike Tea Party conservatives, most liberals believe that ObamaCare, in principle, works. In this view, once the website is fixed — perhaps via a "tech surge," as one Health and Human Services official unfortunately called it — everything else will fall in place as millions of uninsured Americans get access to health care.

But, as Reason's Peter Suderman argues, HealthCare.gov is the hub for 36 state health insurance exchanges, making it "the vehicle through which the law's authors envisioned people choosing ObamaCare-approved, publicly subsidized coverage." With no working website, there is no ObamaCare, he argues, "even with manual workarounds like phone or paper applications."

That means the White House's IT guys must be feeling immense pressure right now. And time is of the essence.

"The system needs to be operating reasonably efficiently — I'm not saying flawlessly — before the middle of November," Sandy Praeger, the insurance commissioner of Kansas, told NPR.

The reason most experts are giving the White House until mid-November to fix ObamaCare is because people need time to sign up before Dec. 15, which is the deadline for people who want their health insurance to kick in on Jan. 1, 2014.

ObamaCare is built on the idea that healthy people who previously didn't have health insurance will sign on to HealthCare.gov and pick a plan, thus subsidizing the high-risk pool of patients and bringing down premiums for everyone.

That could all be in danger if ObamaCare's website still isn't working by December. As Megan McArdle points out at Bloomberg, it's "not impossible to buy insurance" through HealthCare.gov, "but merely very difficult." Healthy 26-year-olds might simply give up after failing multiple times to sign up for insurance.

Conversely, the three groups of people most likely to fight through the website's glitches are the people who are generally more expensive to insure: Sick people, old people, and people with low incomes who live in states that have rejected the government's Medicaid expansion. If these people are willing to battle through a terrible website to sign up, but healthy youngsters aren't, the result could be disastrous for ObamaCare, McArdle argues:

[I]f those are the only people who sign up, insurers will lose a bunch of money on these policies. And then next year, they'll ask for a lot more money. [Bloomberg]

Things could get really bad if HealthCare.gov isn't fixed by Feb. 15, 2014. That is the last day you can sign up for ObamaCare before getting hit with a penalty, currently set at $95 or 1 percent of your taxable income, whichever is bigger.

Imagine the frustration of not being able to sign up for a product and then getting penalized for it. ObamaCare does allow for some health insurance customers to get a "certificate of exemption" to avoid the tax penalty. Some have theorized that the exemption could extend to people who aren't able to sign up for a health insurance plan due to technical problems.

But those certificates would have to be attained through the online exchanges — which, in this nightmare scenario, still aren't working.

That certainly doesn't sound fair. The other option if HealthCare.gov isn't isn't glitch-free by Feb. 15?

"Even liberals concede that the mandate would have to be delayed, because you can't very well fine people for failing to buy a product they can't access," writes conservative New York Times columnist Ross Douthat, adding:

And that combination — a hard-to-navigate online portal and no penalty for staying uninsured — could effectively discourage all but the most desperate customers from shopping ... potentially wrecking the entire individual insurance market in short order. [New York Times]

The longer the White House takes to fix the problem, the worse things are going to get, as more people rush to sign up before the deadlines — putting stress on a system that has already shown it has trouble handling high amounts of traffic. If Obama's IT guys can't fix the problem soon, ObamaCare could be in more danger than it ever was under the threat of Republican repeal.

Keith Wagstaff is a staff writer at TheWeek.com covering politics and current events. He has previously written for such publications as TIME, Details, VICE, and the Village Voice.

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