Why It’s So Hard to Defend Obamacare
I launched a startup and got coverage through the ACA. Now I see its glaring flaws.
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Regardless of your political opinions, it’s clear the current American healthcare system needs urgent (medical?) attention.
The Republicans are repealing Obamacare. That’s sad, because a lot of people will likely lose coverage. But it’s also sad because Obamacare was a good idea that was poorly executed — and we can’t have a productive debate about how it went, because the website didn’t work.
I’m referring specifically to the website of Covered California, the health insurance marketplace made possible by the Affordable Care Act. It’s the primary portal where Californians access their information, learn about their options, and manage their enrollment—and it is essentially broken. How can we trust and defend a complex system when that system can’t even build and host a functioning website?
Building a healthcare system in America that is fair, compassionate, and effective isn’t easy. Many smart people have tried and failed. What we have now is a broken website, a broken system, and, ultimately, a broken dream of fixing one of the country’s biggest problems. We shouldn’t be surprised that it’s under attack. I even benefited from the system — and I can’t defend it.
When I decided to quit my job and launch a startup last year, losing my health insurance was a huge concern. But Covered California seemed like the answer. The website was broken when the exchange first opened, but they “fixed” it by the time I came along. It was definitely janky, but I was able to sign up and pay a reasonable price for a basic plan. I thought I was done.
Then tax season rolled around, and I got the following email:
I decided to do my taxes. It’s amazing how easy TurboTax makes things. It found my W-2s and synced my brokerage account automatically.
Then came time to enter my 1095-A “Health Insurance Marketplace Statement.” I pulled up the email and went to the website to find the form.
What I discovered was an “online marketplace” that was definitely not fixed. It is so broken that I’m surprised anyone has gotten coverage at all.
The email from Covered California told me to find my “Documents” — but that proved surprisingly hard to do.
- As instructed, I clicked on “Secure Mailbox.” That took me to my inbox. A link from the email to “Documents and Correspondence” would have been helpful, but no such luck.
- Clicking “My Account” leads to a screen where the only option is to update your personal info.
- The “Back” button on the browser does not work…at all.
- The top left logo is not clickable; there appears to be no home page.
- Clicking messages in the secure message center opens up pop-ups that Chrome immediately blocks.
- You cannot open any other tabs; doing so logs you out.
Trying to use the online chat or call the help number doesn’t help either; both were closed. This site holds some of my most important information — my social security number; tax documents; eligibility for healthcare — yet it is not usable!
After doing some internet research, it appears that it’s not just me:
I can’t file my taxes because the government can’t provide me with a basic form. This could be fixed so easily by hiring a decent web developer who also has to use the site personally. She’ll add some navigation and a sitemap in a flash, especially if she needs health insurance or a tax form.
I did some research to see why this hasn’t happened. What I found shocked me.
It turns out that Covered California employs a staff of 1,400 people with a budget of over $300 million, of which the technology portion is $50 million. This supports around 1.3 million enrollees—1.3 million people who need access to their data on this website, and end up calling in because they can’t use it.
With a $50 million technology budget per year, Covered California is not bootstrapping this. A website this critical shouldn’t be so antiquated and broken.
Someone should fix this. But who is responsible? It’s so tempting to blame “the government.” The truth of the matter is that this is our government, and this is our fault. We elected the people responsible for this, and apparently Californians are okay with this being the manifestation of Obama’s vision for a better health system.
If Intuit released a version of TurboTax that looked this bad, they’d be out of business and the CEO would be out of a job. In California government, we pay the head of Covered California over $400,000 a year.
Building a functional website isn’t difficult. Millions of individuals and businesses have websites with clear enough navigation and forms. Managing a health insurance exchange at scale seems harder. If the website that 1.3 million Californians see looks this bad, what should we assume about the system behind it?
When Republicans criticize Obamacare, it’s hard to refute them when the government has spent so much money, and basic systems are perpetually broken. I count it as a major triumph that despite these flaws, roughly 20 million more Americans have health coverage.
The Affordable Care Act was a compromise — a way to maintain private, employer-provided healthcare, while dramatically expanding coverage to those left out of the system through state exchanges and subsidies. It wasn’t perfect, but it meant more coverage for more people, more transparency and competition in state exchanges, and a chance to test new solutions to a pervasive social problem. But it hasn’t been a smooth process, and very few people who enrolled can say, “this is awesome.”
It could have been awesome. California could have stood as a shining example of how our state exchange made health insurance accessible, affordable, and convenient. We could’ve shown how the government can support a modern health system with great technology. We could’ve had a slick website. We had the money to do it.
But we squandered our opportunity.
It’s not just Donald Trump who is responsible for rolling back the most ambitious attempt at reforming healthcare we’ve had in decades. It’s the failures of those of us who wanted it to succeed, but didn’t hold our government — and ourselves — accountable.
