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What Obamacare needs to do in year two

Win McNamee/Getty Images

A year ago today, I was endlessly hitting refresh on HealthCare.Gov. It was the Affordable Care Act's second day of open enrollment and nothing ... was ... working. The web site was down. The phone lines were jammed. But it wasn't just HealthCare.Gov. The federal government itself had shut down the day before, after Republicans, led by Sen. Ted Cruz, failed to defund Obamacare.

It wasn't yet clear what was wrong with HealthCare.Gov — if anything. It seemed possible that the site had simply buckled under overwhelming traffic, and the outages actually foretold a successful launch. That turned out to be both very wrong, and very right.

Obamacare's launch was a disaster. The site wasn't down for a day, or a week. It was down for months. The Obama administration had built its most important initiative atop a cracked digital foundation. Worse, they were as shocked by the web site's collapse as everyone else. The technological failure was a management failure: the bad news at the bottom had been hidden from the managers at the top. The launch of HealthCare.Gov will be a campfire story used to scare students in public administration classes for decades to come.

HealthCare.Gov didn't work until the middle of December. The delay should have been a catastrophe; it meant that three of the six months of open enrollment had been wasted. The law's problem at that point was simple math: it now had to enroll as many people in three months as it was supposed to enroll in six — and it had to do so amidst a storm of terrible press and public suspicion.

But just as the site's technical problems were real, so too was the initial crush of demand. By the end of open enrollment, Obamacare had beaten projections that it would enroll 7 million people and enrolled more than 8 million — an outcome that seemed flatly impossible two months before it happened. (Thought experiment time: how many people would Obamacare have enrolled if HealthCare.Gov had worked perfectly from day one?).

Obamacare meme uninsured

The law was badly hampered by its technical failures. But as Sarah Kliff put it, "There's a very simple reason that Obamacare hit 8 million sign-ups: Being uninsured is horrible." Once it was possible for people to sign up for insurance, they did.

A lot has gone right for Obamacare since then. About 7.3 million of those people have paid their bills and stuck with their insurance. Premiums were lower than expected in 2014 and it looks like they'll beat expectations again in 2015. In the 44 states where data is available, the number of insurers offering plans will rise by 25 percent. More states — including ones run by Republican governors — are signing up for the Medicaid expansion. The law is in better shape today than seemed possible during its catastrophic launch.

But the law's second year brings new challenges. Open enrollment begins again on November 15. It has to manage re-enrollment smoothly — which is something the HealthCare.Gov system has never tried before.

HealthCare.Gov also needs to make sure it's easy for people to change their insurer. If the law is going to create the competitive markets it dreams of, it has to try to persuade customers to shop around every year, rather than just pick an insurance plan once and stick with it.

And, perhaps the biggest challenge for the Obama administration is convincing millions of people who sat out the last open enrollment period to sign up this year. The Congressional Budget Office estimates that another 5 million will sign up for Obamacare in 2015. These 5 million new consumers will likely be a tougher sell: they had the chance to buy Obamacare in 2014 but, for whatever reason, decided they didn't want it.

These are also a few of the ways that Obamacare will be disadvantaged compared to 2014. As bad as the law's launch was, it got an overwhelming amount of media coverage. People knew that open enrollment was going on. People had constant reminders to check out HealthCare.Gov. This year, Obamacare will get a lot less attention.

But Obamacare has the same advantage it had last year: it's still horrible to be uninsured. It also has a new advantage of a functional website. And in November, we'll start to learn whether that's enough to convince millions more uninsured Americans to buy the product that the Obama administration is selling.

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