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Obamacare's terrible, horrible, no good, very bad month

(The White House via Flckr)

"If you want people to treat you as credible," Drew Armstrong at Bloomberg News tweeted yesterday, "You can't f*ck up the basics."

This captures the key problem in Obamacare's Terrible, Horrible, No Good, Very Bad November. This has been a month where (depending on your viewpoint) sloppy mistakes or flat-out lies overshadowed the smooth start of a second open enrollment period. Either way, what should have been a great month for Obamacare has become a disaster — and all of it due to unforced errors on the part of the Obama administration and its allies.

A quick recap of Obamacare's Terrible, Horrible, No Good, Very Bad Month:

  • On November 7, the Supreme Court announced it would hear arguments in King v. Burwell, a lawsuit that could effectively dismantle the Affordable Care Act in 36 states.
  • Three days later videos surfaced of MIT economist Jonathan Gruber crediting the "stupidity of American voters " with helping pass Obamacare (this was arguably GruberGate 2, separate and distinct from another Gruber controversy back in April).
  • Another week passes. Another controversy surfaces: it turns out the Obama administration wrongly included dental plans in sign-up figures, inflating sign-up numbers by about 400,000.

The most cynical reading of these events says the Obama administration repeatedly lied and intentionally misled the public. Health and Human Services meant to goose enrollment numbers so it could stay above enrollment projections. Congress, in consultation with the White House, really did want to limit subsidies to state insurance marketplaces as the new Supreme Court case charges — and has since tried to obscure the fact after realizing how disastrous this would be for Obamacare.

But the most generous reading of No Good, Very Bad November isn't great for the Obama administration either. It offers a narrative where the Obama administration and its allies kept making sloppy, dumb mistakes as they crafted, implemented, and tracked a massive overhaul of the American health care system.

The sloppiness defense

obama burwell

President Obama and Health and Human Services Secretary Sylvia Burwell meet in mid-October (Alex Wong / Getty News Images)

The most consequential of these errors is the sentence in Obamacare that opponents have seized on to say that federally-run insurance exchanges can't offer enrollees subsidies — the issue at the heart of the King v. Burwell lawsuit.

While former Obama administration officials think the suit is ridiculous, they agree the bill's language was frustratingly vague. "I would ascribe it to a kind of cut-and-paste mindless drafting rather than any intentional, purposeful thing," Peter Orszag, who ran the Office of Budget and Management during the health reform debate, says of how the sloppy legislative language came to be.

On Thursday, Health and Human Services offered a similar defense for the botched Obamacare enrollment numbers. Health and Human Services Secretary Sylvia Burwell tweeted Thursday that the agency made a "mistake" that was "unacceptable."

Jonathan Cohn at the New Republic has some of the details on how Health and Human Services says they botched the figure:

Administration officials told me that, during the spring, they used an internal system for tracking how many people were shopping and selecting new insurance plans. That system distinguished between health and dental policies, and didn’t count the latter towards the sign-up totals. But, as you may recall, that data didn’t provide a critical piece of information: How many people were actually paying for their plans. To get that information, HHS got information  directly from insurers and used it to produce the autumn numbers. When they did so, they didn’t think to break out dental plans—and ended up including them accidentally.

Even if believe this account — which Republican legislators do not — it doesn't exactly inspire much confidence. It suggests that the federal government was very sloppy with how it measured the impact of the administration's signature legislative accomplishment.

As for Grubergate, Jon Gruber has repeatedly said he "spoke inappropriately" in his comments about American voters.

The administration's trust problem


"People are going to be more skeptical of HHS figures in the future," Jonathan Cohn at the New Republic writes. (Mark Wilson / Getty News Images)

The enrollment numbers, the King case, the Gruber comments — all of them give the public less reason to trust the Obama administration with a law that they don't like much to begin with.

This is the second open enrollment period that the Obama administration has waylaid with its own mistakes. Last year was a different sort of sloppiness: was a poorly built website that barely functioned at its launch. It took about months of work and improvements to make a place where shoppers could reliably purchase coverage.

This year, website seems to be working great — it launched this weekend, and reports of errors were few and far between. But all these other mistakes have overshadowed that fact. They make it seem like Obamacare is having a pretty disastrous second open enrollment period when, if you look at the experience of people signing up, it's actually going pretty well.

No person, or presidential administration, is perfect. Mistakes happen. But this steady stream of screw-ups means that "people are going to be more skeptical of HHS figures in the future, for understandable reasons," Cohn writes. When the White House releases monthly enrollment numbers — figures that are expected to be higher than last year — the public will doubt them. And it's just at the moment that Obamacare's marketplaces are running better than ever that this series of sloppy mistakes make it look like worse than anyone thought.

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