http://dyn.politico.com/printstory.cfm?uuid=8E429763-EBB7-48B7-92A2-B01A2C0D3D5E New strategy: Underselling Obamacare for Year 2
By: Jennifer Haberkorn
October 12, 2014 10:48 AM EDT
The Obama administration vastly oversold how well Obamacare was going to work last year. It’s not making the same mistake this year.
Gone are the promises that enrolling will be as easy as buying a plane ticket on Orbitz. The new head of HHS is not on Capitol Hill to promise that HealthCare.gov is on track. And no one is embracing Congressional Budget Office projections of total sign-up numbers.
Sobered — and burned — by last fall’s meltdown of the federal website, the administration is setting expectations for the second Obamacare open enrollment period as low as possible.
Officials say the site won’t be perfect but will be improved. They refuse to pinpoint how many people they plan to enroll, instead describing general goals of reducing the number of uninsured and providing a positive “customer experience” — not exactly metrics that can be immediately judged.
“What we have said is that the experience will be better,” Health and Human Services Secretary Sylvia Mathews Burwell told reporters on Thursday. “It will not be perfect. We know that, and we know that there will be issues that will be raised as we go on in the process.”
Andy Slavitt, principal deputy administrator for the Centers for Medicare & Medicaid Services and one of the people responsible for HealthCare.gov’s technology, wouldn’t make any projections on how the website would operate when open enrollment begins Nov. 15.
“We are much more comfortable talking about results than expectations,” Slavitt said Wednesday. “We are extremely focused on meeting our milestones. We’re very focused on making sure that everyone has a good customer experience.”
It serves as little surprise that the administration is not predicting website performance next month or how many people will sign up during the three months that follow. Last year, the site’s weeks-long failure compounded opponents’ message that the law wasn’t working. And by embracing the CBO’s enrollment target, the White House found itself boxed in with a political goal to meet, even if the figures didn’t really have any policy significance.
Even Obamacare critics say they’re not surprised the administration is downplaying expectations.
“I certainly can’t fault them for being circumspect,” said Rep. Michael Burgess (R-Texas), one of the law’s loudest critics on Capitol Hill. “I would do the same if I was in the situation,” he said, given last year’s collapse.
Yet there are signs that the technology could be appreciably better this time around.
The new HealthCare.gov application, which is already online and accessible to those who are eligible to enroll because of changing life circumstances, has been whittled from 76 pages to about 16 for most individuals. It was redesigned so that information is not sent to the federal data hub after each question is answered — which slowed the process last year — but rather, all at once at the end.
The administration held a successful demo for reporters last week. But Slavitt and Kevin Counihan, the website’s CEO, were reticent when asked if it would operate as smoothly when there is significantly more demand.
Slavitt instead pointed to what HHS is doing to prepare — such as load testing, testing with insurers and full end-to-end testing — and the goals already met. That end-to-end testing started on time last week, he said. Officials are hoping to have the site prepped for up to 125,000 concurrent users, the record hit during the first open enrollment period.
Burwell also avoided making any promises about the future. And she, too, stressed “not talking about expectations but about results, and that’s what we’re focused on. … Every day, we are working through the deadlines that we have internally to get us to what we have said, which is a good consumer experience for open enrollment.”
Ron Pollack, executive director of Families USA, said that Burwell’s hires of Slavitt, Counihan and others have given him confidence that the technology will in fact be better.
“She is focused very heavily on people who have technological and administrative strengths,” Pollack said. “Clearly, after the experience of the first open enrollment period, the emphasis throughout the department has been on making sure the technology and administrative systems work effectively.”
Administration officials are even more reluctant to peg an enrollment goal.
Last year, then-Secretary Kathleen Sebelius said the administration was aiming for the CBO’s estimate that an average of 7 million people — later recalculated to 6 million — would be enrolled in the federal and state exchanges in 2014. That immediately became the political bar to meet during open enrollment, with the risk that any shortfall would be labeled a failure.
Although Obamacare supporters ultimately surpassed political expectations with 7.3 million people covered as of August, the administration endured headline after headline over whether the law would be successful.
Some of the law’s supporters say that last year’s CBO target wasn’t ever an indicator of success.
“We didn’t think the enrollment targets really meant anything last year,” said Edwin Park, vice president of health policy at the Center for Budget and Policy Priorities. “It’s really the mix of people enrolling and improving the risk pool.”
And while there is another projection for this year — CBO expects that an average of 13 million people to be enrolled in the exchanges during 2015 — Burwell steered clear of the trap of embracing it for the open enrollment period.
She suggested that the law’s future success should be judged by the reduction in the nation’s uninsured figures, whether that’s accomplished through the exchanges, Medicaid or employer-sponsored care.
“Now we actually have information about what happened in the first open enrollment,” she said Thursday. “We want to try and to build that number, bottom up, based on what we know [about] those who did enroll.”
