October 22, 2013
Is HealthCare.gov synonymous with the Affordable Care Act, President Obama’s landmark health care reform law? Or at least with the health insurance marketplaces that act introduced and that launched Oct. 1?
Or is HealthCare.gov just a website, a tool that helps people reach those marketplaces but that doesn’t encapsulate or define them?
That question may sound irritatingly metaphysical, but it gets to the heart of one of the biggest questions in government technology today: Whether technology is a backroom function that assists government operations or an integral part of how government does its job that can’t be neatly separated from citizen services themselves.
Most government technologists use the latter definition, arguing that chief information officers and other technologist should have a seat at the table, along with Cabinet secretaries, deputy secretaries and chief financial officers, when major decisions are made. Some officials and subject matter experts still hold to the former definition.
This debate came to the fore on Monday when President Obama apologized for numerous glitches that have beset HealthCare.gov since its Oct. 1 launch but sought to separate those glitches from the major focus of The Affordable Care Act, popularly known as Obamacare.
The president likened the HealthCare.gov glitches to a cash register malfunctioning while a customer is trying to purchase an otherwise high-quality product.
“We did not wage this long, contentious battle just around a website,” the president said. “That’s not what this was about. We waged this battle to make sure that millions of Americans in the wealthiest nation on earth have the same chance to get the same security of affordable quality health care as anyone else.”
Rep. Darrell Issa, R-Calif., chairman of the House Oversight and Government Reform Committee and one of the president’s chief critics, responded in a tweet moments later:
#ObamaCare is not just a website, it's the reason your deductible tripled http://t.co/V2irMkLTP5 #TrainWreck— Darrell Issa (@DarrellIssa) October 21, 2013
To be clear, a large part of this is politics with a veneer of technology.
Obama and Issa are two of the most tech savvy elected officials at the national level and using technology to improve how government works is one of the few areas they typically agree on. It’s unlikely Obama would be making the product-cash register distinction if HealthCare.gov was running smoothly. And Issa would likely have more patience with a site that supported a policy he wasn’t ideologically opposed to.
That said, it’s worth being clear about just how important technology is to government programs. And, on balance, this debate should go to Issa.
History has never judged programs by the ambitious and hard-won legislation that crafted them. They’re judged by how they’re implemented. And, these days, that nearly always includes how well the technology underlying them functions.
Let’s be specific. People who already receive health insurance from their employers are eligible to switch to an Obamacare plan if their current coverage is inadequate. But many of these people have been unable to process their applications, according to a Washington Post report.
If some portion of those people stick with their skimpy workplace plans even though a superior or cheaper plan is available through HealthCare.gov, either because they’re frustrated or don’t trust the site’s security, that’s an implementation failure.
Now, let’s look at the macro level: The health care law requires that everyone obtain health insurance or pay a penalty (amounting to 1 percent of his or her income in 2014). The system also depends on young and healthy people buying insurance in order to keep premiums low for older people who typically spend more on health care.
If more of these young and healthy people choose to go without insurance and pay the penalty rather than purchasing insurance through the exchange -- either because it’s too much of a hassle or because they’re concerned the site won’t securely process their financial information -- that’s an implementation failure and one that could threaten the program’s long-term viability
The jury’s still out on HealthCare.gov. On Sunday, the Health and Human Services Department announced it was bringing in a team of experts from inside and outside government to work around the clock to repair the site. President Obama promised in an address on Monday that the site would be up and running soon.
It’s quite possible these early glitches will be a bump on the road toward a successful operation. But people who support the major goals of the president’s health care reform plan, should be very concerned that its implementation is going poorly.
A Washington Post-ABC News poll released on Monday found that 56 percent of Americans believe that HealthCare.gov’s flaws reflect larger problems with the health care reform law. They’re right.
October 22, 2013