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ObamaCare’s Self-Sabotage

Earlier today Jonathan tackled the accusation from the left that conservatives rooting for ObamaCare to collapse under its own weight were being disloyal. Indeed, there has been a broad attempt to force dual responsibility for the law by instituting a “good Samaritan law” of the sort that landed the Seinfeld klatch in jail in the show’s finale for laughing at the realtime misfortune of others. Here is Dana Milbank’s unconvincing plaint:

Their outrage has not been softened by the knowledge that the bulk of the sign-up problems has been in the states led by critics of the law who refused to cooperate with the federal government on the rollout. Essentially, Republicans are complaining about flaws created in part by their own sabotage.

When the spin is this laughable, you know the truth must be devastating. The law provided the states the choice of setting up their own exchanges. Those who didn’t voluntarily do what the Obama administration wanted them to are apparently saboteurs, not for rooting for the law’s failure but merely for not saving the Democrats’ asinine plans from themselves. Milbank seems to be suggesting that allowing the Democrats full control over the implementation of massive reform is a devastating mistake. I’m sure most Republicans agree with that, at least.

But now there’s some indication that rooting for the law, or at least the healthcare.gov insurance portal, to fail is actually the humane thing to do. That’s because, as Milbank’s colleague at the Post Sarah Kliff reports, there are problems with what is referred to as the 834 transmission, which “is the one form, in the giant machinery of HealthCare.gov, that lets insurance companies know who signed up for their product.” It’s a very important digital record, but those 834 transmissions are also glitchy: many of them apparently have the wrong consumer information on them, which Kliff says is a much larger problem than a slow website:

An 834 transmission contains enrollment data like an individual’s social security number, their dependents and the plan that they picked. That data is, obviously, critical: If it comes in wrong, an applicant may not get the right plan, or family members may not be covered, or identity may not be verifiable.

And guess what would turn the 834 transmissions glitch into a full-fledged disaster: that’s right, fixing the website too soon! Kliff explains:

Right now, health-insurance plans say they can manage these problems. Few enough enrollment forms are coming in that they’re able to hand-check each one. “What our company, and I’m assuming others, are doing is throwing people at it,” one insurer told Wonkblog. “We’re overcoming the tech flaws with manual reviews and manual rigor and manual processes. That’s fine right now, but when you start looking at the scale of what the Obama administration wants to do, that’s just not going to scale up.”

This approach undermines the very point of 834s, which is to make it possible for the computer system to automate the process of enrolling tens or even hundreds of thousands of applicants each day.

“The purpose of the electronic transaction is to be able to do this with a minimum amount of human intervention,” says Stanley Nachimson of Nachimson Advisors, a health IT consulting firm. “The hope would be that the health plan’s computers will be able to understand the transaction and do all the processes automatically.”

Some in the industry believe HealthCare.gov’s traffic problems have been a blessing-in-disguise for the program: If applicants were being able to sign up easily but the 834 forms were coming in with this many errors the results could be disastrous.

Let that sink in. The “train wreck” rollout of ObamaCare via a horrendous website was a blessing in disguise because it likely would have been a lot worse if people had actually been able to get coverage. It’s possible the system can overcome its initial failure, but ObamaCare might not have been able to survive its own success.


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