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Government, Politics & Issues

Commentary: Hard lessons from the ACA roll-out

This article originally appeared in the St. Louis Beacon. - As a professor of public policy I am always on the lookout for events that I can use as Teachable Moments in the classroom. The rollout of the Affordable Care Act, aka Obamacare, certainly qualifies as a case study of what not to do when implementing a new public policy.

You do not have to buy the GOP argument that the ACA is fundamentally, irretrievably flawed to recognize the Obama administration did a less than competent job in introducing the health exchanges last month.

This is all the more surprising given three things: 1) It had three years to prepare for the roll-out, 2) The ACA is probably the single most important piece of legislation to emerge from the Obama White House, and 3) The Obama team won both elections in 2008 and 2012 in large part because of its technological acumen.

The poor execution of the ACA’s rollout confirms two well-known attributes of public policy that I frequently refer to in the classroom: Perception is everything in politics and the Law of Unintended Consequences.

Simply stated, the Law of Unintended Consequences ia a common property of public policies -- in particular, vast, complex ones -- to have consequences that are often at odds with what lawmakers intended.

The ACA woes could not be worse or more undermining of the law’s long-term acceptance had the GOP been responsible for introducing the president’s signature health policy reform. That it is the Obama administration itself that is behind the flawed implementation is simply mind-boggling.

First, technical glitches prevented people from using the online exchanges. Initial reports indicate that slightly more than 100,000 have enrolled in the new federal and state exchanges. This figure is significantly below the administration’s expectations before the ACA was unveiled. The goal of the administration was to have several million people enrolled by the end of the first year. It appears highly unlikely that this lofty aspiration will be achieved by Oct. 1, 2014.

Second, thousands of Americans (the exact total is not available) have had their private insurance canceled by their insurers. This seems in direct contradiction to Obama’s claim that if people were happy with their coverage they could keep it.

What he meant but did not actually say in the lead-up to the 2012 election was that you could keep your current plan if it otherwise met the ACA’s legal requirements, for example, no more than 15 percent of your premium goes to administrative costs; if it covers the 15 essential services enumerated in the ACA, etc. That those who risk losing their current plans actually stand to gain is beside the point since perception is everything in politics. The one thing those people know for sure is that their insurance plans are being canceled and that until the exchanges start working, they are effectively without insurance.

GOP and Democratic plans currently circulating in the House would allow people to buy plans outside of the exchanges (particularly younger people), which would leave sicker and older people to use the ACA and in the process drive up premiums. This would have the unintended consequence of making the president’s health care program more expensive than initial reports indicated.

Another unintended consequence of the rollout is that it gives credence to the Republicans’ claim that government would do a worse job of providing health insurance than the private market.

Granted the GOP has no alternatives but that is the point: Its members have always argued that the marketplace would take care of everything if we just got government out of the way. At best, the GOP argues that some tweaking of the current system would fix the problems but a massive overhaul, which they claim the ACA represents, would end up doing more harm than good.

The Economist, a highly respected British news magazine, says, “The future of health care in America inevitably involves more rationing and less consumer choice.” What this means in plain terms is that to expand affordable coverage to more people, those with low-incomes and pre-existing conditions, others will have to pay more and get less. Private insurers would go broke if the entire burden fell on them to cover the poorer and sicker members of society.

At the end of the day, the Obama administration’s legacy rests in no small measure with the success of the ACA. There is time to reverse the negative perceptions created by the fumbled rollout. The unintended consequences of the law can be mitigated over time as well. However, the political window of opportunity is closing quickly and once that happens, it will be very difficult to pry it open again.

Robert Cropf chairs the Department of Public Policy Studies at Saint Louis University.

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