Obamacare: Repair It or Repeal It

Now that coverage for the first wave of Obamacare applicants has taken effect as of January 1, another checkup is in order, and some improvement in its health — and ours — may be noted.

HealthCare.gov appears to have survived its initial, glitch-heavy rollout in October. The do-or-die overhaul of the website saved the system. Hundreds of coding errors were repaired, it emerged from fatal error mode into a functional phase, and people are signing up.

But while Obama administration officials are no doubt wiping their brows in relief, the brows of millions of Americans seeking health insurance are still furrowed in frustration and worry.

Problems persist. Parts of the system still don’t work, and it still lacks certain “back end” features, such as a payment system for insurance companies. This is not to mention the 13,000 people whose insurance is being held up by various technical issues who have been remanded to a “caseworker system,” an unfortunate nomenclature that makes it sound like they’ve been placed in the hands of social workers.

The government is not oblivious. It’s replacing CGI, the computer contractor that perpetrated HealthCare.gov. As CGI goes off to spend the rest of its corporate life trying to live down this ignominy, Accenture Plc (ACN) will take over. Accenture, the second-biggest technology-consulting company, led construction of California’s better-performing state exchange, but it has its share of critics too. Time will tell if they can get it right.

Beyond the website, all is not well either. Many who signed up for coverage through the state and federal exchanges are finding out what they probably knew in the first place — that bureaucracy hasn’t forgotten how to create local exasperation out of universal good intentions. Though exchange officials and insurers have urged consumers to call their insurers if they encounter problems, many say they either wait endlessly on hold or get a runaround.

Beyond computers and bureaucracy, Obamacare may ultimately be defeated by demographics. More than 2 million people have signed up for the private insurance

The viability of the new system depends on a more conducive cohort than they’re getting. To make Affordable Care affordable, the administration needs more young adults to sign up in the next three months to help offset costs from older enrollees and prevent insurers from raising their rates.

So far, the numbers are disappointing. Early readouts show that of more than 200,000 enrollees, about 22 percent are 18 to 34. The administration had hoped that over 38 percent, or 2.7 million, would be in that age group based on a Congressional Budget Office estimate that 7 million people would sign up by the end of March.

There is reason to be hopeful that better statistical days are just around the corner. A recent survey by The Commonwealth Fund, a health-care research foundation, found that 41 percent of those who had shopped at the various state marketplaces by the end of December were 19 to 34, up from 32 percent in October.

But if those young folks don’t decide to buy in soon, rates will have to go up.

There is a certain irony in all this. When Obamacare was being debated, other issues often occupied center stage: that it would wreck not only the health-care system but the nation’s economy; that the law’s requirement that most Americans purchase health insurance was unconstitutional (since rejected by the Supreme Court); that the law would create “death panels” of bureaucrats who would decide whether the elderly and children with birth defects were “worthy of medical care.”

Whatever the merits of those arguments, the opposition to Affordable Care has shifted from the principled to the pragmatic and personal. Many now believe that the program just doesn’t work — that it’s too big and unwieldy — a conclusive demonstration that more government is not going to solve our problems. Others, including many who initially supported Affordable Care, feel betrayed. The oft-repeated promise, “If you like your health-care plan, you can keep it” turned out not to be the case. Not least, the anecdotal force of the tales of woe from people who have gotten snarled up in the system contributes immeasurably to a nationwide case of buyer’s remorse.

Republicans are already identifying Obamacare as the central issue of the next election. Senate Minority Leader Mitch McConnell said Friday that if Republicans regain control of the Senate, he would move to repeal the health-care law regardless of a likely veto threat. Several major polls show that 49 to 55 percent of Americans favor repeal.

Is the country really ready for another grueling battle over health care? We don’t know. But in the end we might be spared. The fact is, the original Obamacare no longer exists. The individual mandates have been whittled down by the administration itself in the face of tough resistance, and sign-up rates are smaller than expected.

It could be that instead of a painful, high-risk repeal operation we will have a gradual scale-down — not repeal, but modification and marginalization. If so, it would be a healthier outcome.