Rocky health care rollout raises concerns of low enrollment, high premiums

With coverage deadlines for the Affordable Care Act nearing, and estimates by Internet experts that it may take weeks to fully fix the glitches plaguing the online insurance exchanges, what’s the outlook of health care reform? Judy Woodruff gets analysis from Sherry Glied of New York University and Gail Wilensky of Project HOPE.

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    Our lead story tonight: The president today joined the wave of criticism that has greeted the rocky rollout of online efforts to get people to sign up for health insurance. He conceded the federal Web site central to the process has failed to deliver.

    From the outset, has been plagued with problems.

    DAN HOWARD, seeking health insurance: Hour after hour after hour of just trying to find the answer to the question, where am I going to have my insurance and what's it going to cost?

    JOHN TANKERSLY, seeking health insurance: For the first week, I tried through three different days to try to just log on.


    The Affordable Care Act's…


    Today, in the White House Rose Garden, President Obama added his own criticism to the mix, saying there is no excuse for what he calls kinks it in the system.


    There's no sugarcoating it. The Web site has been too slow. People have been getting stuck during the application process. And I think it's fair to say that nobody's more frustrated by that than I am.

  • GWEN IFILL: opened for business on October 1. The president said today there have been nearly 20 million visits since then. And according to administration officials, nearly half-a-million people have applied for insurance there and on state-run Web sites.

    They won't say how many have actually enrolled. The president offered no explanation today for why the rollout has been so chaotic. But he emphasized there are other ways to enroll.


    Nobody's madder than me about the fact that the Web site isn't working as well as it should, which means it's going to get fixed.




    And — and, in the meantime, you can bypass the Web site and apply by phone or in person. So don't let problems with the Web site deter you from signing up or signing your family up or showing your friends how to sign up, because it is worth it. It will save you money.


    A national survey by the Pew Research Center found 46 percent of Americans don't think the health care exchanges are working, compared to 29 percent who think they are.

    The website troubles have also fueled new attacks by Republicans.

    Senator John McCain appeared Sunday on CNN.

  • SEN. JOHN MCCAIN, R-Ariz.:

    It's been a fiasco. Send Air Force out to Silicon Valley. Load it up with some smart people. Bring them back to Washington and fix this problem. It's ridiculous, and everybody knows that.


    The president said today his Republican critics are rooting for failure, but that consultants and contractors have been called in to fix the Web problems.


    Now, the rocky start of the new health care exchanges.

    Internet experts have suggested it may take weeks to fully fix the federally run Web site so that it runs smoothly for consumers as deadlines approach this winter. We look at what's at risk, politically and pragmatically.

    Sherry Glied was an assistant secretary in the Department of Health and Human Services for the Obama administration. She left last year, and is now the dean of the New York University Wagner Graduate School of Public Service. And Gail Wilensky, a health economist at Project HOPE, she's served on numerous government advisory boards and oversaw Medicare and Medicaid for President George H.W. Bush.

    Welcome to you both to the NewsHour.

    Sherry Glied, to you first. You were in the government at the department up until a year ago. How serious do you understand this problem to be?

    SHERRY GLIED, former U.S. Assistant Secretary, Department of Health and Human Services: Well, I haven't heard directly from anyone in the department.

    It seems that the big problems have to do with the initial interface with the Web site. And that really doesn't seem to be going very well yet. Hopefully, it will be fixed soon. But at this point, there's a real problem in terms of just accessing the coverage options.


    And, Gail Wilensky, what is your sense of how serious this is?


    It is very serious.

    Many of us thought the rollout might be a bit rocky and bumpy. I don't think anyone anticipated the kind of difficulties and frustrations that people are reporting. The administration has a couple of weeks to get this fixed. But it needs to do it in a hurry.

    Otherwise, the question of whether people will be able to enroll before a January 1 start becomes a serious issue. And, of course, the question of when they will be liable if they don't have coverage also is going to get raised.


    Well, Sherry Glied, let's — let's talk about that. What are the risks, first of all politically, if this isn't fixed quickly?


    Well, I guess, you know, you really have to separate sort of the short-term and long-term problems.

    The short-term problems, over the next month or so, there is going to be a lot of oversight. It's going to be very ugly and unpleasant. There will be a lot of people talking about what a disaster it is. The real question is whether the Web site can get going and enrollment can really pick up around December, because that's when people need to enroll in order to be able to get coverage beginning in January.

    And the period between December and March, which is when the mandate kicks in, is really the period when we really expect people to get enrolling in coverage. So that's what is really critical. As long as the problems are fixed before, say, mid-December, things should be fine, except for the short-term unpleasantness, political unpleasantness.

    The problem is, if it goes on after that, deadlines will start to be missed. It will be harder to get the kind of enrollment in the first year of the program that the administration has been hoping for.


    Gail Wilensky, do you see the timeline as Sherry Glied just described it, and how does the political reaction play into this?


    I think the timeline is a little shorter.

    What I have been hearing and talking to people is the administration really needs to have this problem resolved by mid-November. Otherwise, one of the problems that people have been worrying about, that it will be the sick, the predictably high users that will do whatever it takes to enroll. But getting the young immortals, people who are likely to be low users, they're going get discouraged easily because they weren't really sure they wanted insurance in many cases in the first place.

    They're the ones that you worry about. If they don't pursue getting insurance, the premiums that will result will be unsustainable. That's the biggest risk in this first year , that only the high users will go through whatever it takes to get the insurance that they have wanted or have had in these high-risk pools.

    The politics are to raise questions about, will the administration be forthcoming? Thus far, stonewalling about what the problem is and how many people have enrolled isn't helping restore the confidence that the administration understands it has to get it fixed and will be forthright with what they know.

    The president, I know, attempted to correct some of that today by his very strong statements. My advice is, share the information on enrollment biweekly as you have them. They don't have to be real high now. They have to start getting high by the time December rolls around.


    And, Sherry Glied, I mean, how — how much more transparent can the administration be and should they be?


    Well, I'm hoping that they will start to put enrollment figures out in early November.

    I guess it's really important to know that the young immortals, the people we expect will get coverage just because of the mandate, the experience that we have seen — we saw in Massachusetts is that those people are the very last ones to sign. They are going to be the ones who are signing up in February and March.

    So, in that sense, I think they have a little bit more time on the clock. And we will be really interested in looking at the enrollment figures as January, February and March come around. You expect to see the early enrollments to be mostly people who are really sick and are transitioning into the exchanges.


    Staying with you, Sherry Glied, what about the point, though, that Gail Wilensky made that it's really a November deadline, that if things don't start getting better by November, it's going to create bigger problems down the road?


    Well, it would certainly be nice if things started getting better in November. But I do think it's really important to look at the experience of other programs.

    Prior experience with doing things like this, is that the people you really worry about, who are those young, healthy people, they're not the ones who are enrolling in November for something they don't have to buy until March. So, you know, I think what we're going to be seeing in the early days is really people who are very anxious about getting coverage who are signing up.

    And that's kind of consistent with what we have already seen. If you were looking at the news reports in a couple of weeks before the rollout happened, what everyone was worried about is that no one would hit the exchanges. All the stories were about how nobody knew anything about this and no one was going to sign up.

    Instead, there has been this enormous rush of people, and I think they have mostly been — a lot of them are curious, you know — curiosity, people who are just curious about how the whole thing is working, and many of the others are the sicker people who are trying to get coverage to replace coverage they already have.


    Gail Wilensky, are there other things the administration can do? Clearly, they have got people working nonstop on this. We have been told the contractors, people who worked on the Web site, are now going to testify on the Hill before committees looking into this later this week.

    But what else — I mean, are we — are we potentially talking about delaying the deadline?


    Well, that's certainly going to be regarded as a last resort by the administration.

    The administration made a policy call early on that I think has exacerbated the problem. They didn't want to have people do what is called anonymously browse, that is, look at the different options before they actually enroll and sign up.

    And the concern was that if they saw the premium price without the subsidy that they could be eligible to receive, that might scare some people off. But what it meant is that many people who right now are just looking to see what the options are have to go through that very arduous enrollment process before they can get that information.

    Now, I have been told multiple times that there is a different way that you can do it now. But when I have personally gone on the Web site to see whether I can find that way of looking at the plan choices and not having to enroll, it takes me about six screens and then I get dumped back into the enroll now request.

    So, if it is on, it's not obvious to somebody who is reasonably proficient in getting around the Web site.


    Well, a work in progress in more ways than one.

    Gail Wilensky, Sherry Glied, we thank you both.


    Thank you.


    Thank you.