Where Obamacare Is Working and Why It Matters

In his latest take on the implementation of the Affordable Care Act, and the much-publicized issues with the system for enrolling people in health insurance exchanges, TNR’s Jonathan Cohn draws attention to the places where enrollment has not been a disaster: in the states that agreed to set up the exchanges themselves:

Obamacare’s architects assumed that most states would opt to run their own marketplaces, with federal officials running only a few. The assumption proved wrong: Pretty much any state with a Republican governor or Republican legislative control said no, adding to the administrative burden on HHS. But 14 states plus the District of Columbia are managing their own markets. Mostly it’s places you would expect—progressive outposts like California, Washington, and New York—where Obama and his policies are most popular. But Kentucky, where a Democratic governor and group of dedicated officials have worked diligently to deliver the law’s benefits, is also on the list.

Some of these states are still having major problems: Hawaii, which relied on the same contractor as HHS, seems to be in the worst shape. But the websites in other states are now running and, while it’s difficult to get a precise sense of how each one is operating, most appear to be functioning well. They may have more traditional glitches, like random error messages or delays in certain features. (California had to hold off introducing a tool that allows people to check provider networks online.) And most had trouble on the first day or two. But since that time they’ve been running more smoothly.

There are two lessons to carry away from the relatively solid performance of states in the enrollment process: (1) many of the very people complaining about the “Obamacare train wreck” and the alleged tyranny of “nationalized health insurance” could have mitigated many of these problems by cooperating with the law, and (2) the problems do not seem to have much to do with any inherent flaws in the basic structure of the law and the system it creates.

Yes, it’s been obvious for a while that in most if not all parts of the country Republicans have been engaging in active sabotage of Obamacare, and yes, implementing a system involving public mechanisms for enrollment in and subsidies for private health insurance is going to be more complicated than, say, a single payer system. But there are growing signs that by the time exchange-facilitated coverage goes live in January, the current snafus should be just a bad memory. And that’s all that really matters.

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Ed Kilgore

Ed Kilgore is a political columnist for New York and managing editor at the Democratic Strategist website. He was a contributing writer at the Washington Monthly from January 2012 until November 2015, and was the principal contributor to the Political Animal blog.