In looking at the major provisions of the Affordable Care Act so much in the limelight of late, we find that popular features that required no government effort to implement have quietly gone into effect: a child can continue to be covered on his parents’ insurance until age 26; there can be no rejection of insurance for someone with existing conditions; insurance companies must return excessive premiums to their clients; insurance companies must justify any premium increase that exceeds 10 percent; annual wellness checkups are provided at no cost to the insured; etc.
Other major features, such as the requirement for larger businesses to insure their employees (“business mandate”), have been delayed by presidential directives. The goal of making insurance available to the poor has been largely defeated by the Supreme Court’s ruling that the states do not have to expand Medicaid, leaving a large segment of the population in an uncovered gap between 138 percent of the poverty level and the lowest level of subsidized private coverage. This gap is even worse in Texas, with an estimated one million poor Texans unable to receive subsidized health care.
But a vitally important government responsibility — to allow citizens to find federally subsidized insurance coverage through a government-run health care marketplace (fulfillment of the so-called “individual mandate”) — is failing miserably, with insufficient computer facilities and, much more importantly, improperly designed software that allows browsing for insurance coverage only after completing a long, drawn-out registration process. Of course, some personal information must be known in order to make browsing for insurance coverage meaningful, but a full-blown registration is not needed.
Correcting the flaws
Computing facilities can be expanded quickly, but some estimates suggest that months of redesign and reimplementation will be required to correct the software flaws. Given that 3½ years were allowed to implement the present flawed system, who knows how much longer it will take before a working design can be implemented?
For some reason, President Obama directed that the business mandate be delayed, even though it could have been implemented with only minor government intervention, while refusing to delay the individual mandate, where almost all of the implementation demands were placed on the government.
This overloaded system might be made to work with only minor changes by adding a common-sense front-end requirement that only a subset of the population may use the system at a given time, such as those with last names beginning with the letters A-D on Monday, E-I on Tuesday, … U-Z on Friday, and anyone on the weekend. I can remember a similar scheduling system being used way back during college registration days.
But knowing that any common-sense approach will be rejected, it seems to me that the individual mandate of Obamacare should be delayed for a year. In the meantime, while the software is being redesigned and reimplemented, Congress should amend the legislation to eliminate the major deficiencies and flaws, and especially the coverage gap for the poor in the states that refused to expand Medicaid. Otherwise, we will have an expensive health care system nobody wants because it fails to provide the intended coverage for the poor while further subsidizing coverage for those who can already afford it.
Herbert R. Haynes is a retired professor of computer science at Texas A&M University-Corpus Christi. He and his wife, Carolyn, live in northwestern McLennan County near China Spring, about halfway between their grandkids in Dallas and Austin.