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Commentary: The Rough Start to the Insurance Exchanges Doesn’t Matter

The level of hysteria surrounding the rollout of the Obama administration's new website HealthCare.gov is something to behold. "Is Obamacare President Obama's Iraq war?" a reporter tweeted Monday just before Obama gave a Rose Garden address on the rough start to the Affordable Care Act's online health insurance exchanges. Another compared it to Hurricane Katrina.

Conservatives and the media have been hounding the president for his administration's shoddy website, his staffers' unfortunate choice of words and for giving the same press conference he would have given if the law's implementation had been smooth. None of that matters very much.

There are two issues facing the administration right now with respect to the ACA. One issue is that the administration's website doesn't work. The other is whether Americans will have access to quality, affordable health care coverage come March. That's what actually matters. And so far there's no reason to think that the answer to that latter question is no. Not yet, anyway.

In a private background briefing with a handful of journalists in the West Wing on Monday, the administration did not make any promises as to when its website would be up and running. "It isn't the nature of computer glitches to say with 100 percent certainty this will be fixed by X date," an official explained. Said another, when pressed, "I can't say to you right now whether it's a day or a week. What I do know is that we are throwing everything at it 24/7."

A reporter asked if it was possible the website couldn't be fixed. "We don't believe that to be the case," an official said.

We are currently three weeks into Obamacare's six-month open enrollment period and still the website has not been fixed. That's a far cry from a death sentence. Officials said Monday that they expected enrollment in October to be low, with a spike in December prior to benefits beginning in January, and another spike in March before the individual mandate kicks in. Young people, in particular, are expected to sign up closer to deadline, according to the administration's models.

Those models aren't baseless. When Massachusetts rolled out a similar health insurance mandate in 2007, the biggest spike in enrollment came in the two months leading up to the time that people would be charged a penalty for not having coverage, according to Jon Kingsdale, who ran the state's health-benefit exchange at the time.

"The analogy is imperfect but the the logic is correct," said Kingsdale, now a health exchanges and health care reform expert with Boston's Wakely Consulting Group. In Massachusetts, nobody was signing up in October for insurance they would receive in January, and Kingsdale said he'd always assumed enrollment for Obamacare would be relatively low too. "Not a lot of people want to pay in October for benefits that don't start until January," he explained.

That's not to say the Obama administration has the problem under control. Details about what's gone wrong with the site have been extremely vague. We still don't have a clear explanation of what went wrong and there's reason to think the problem can't be fixed particularly quickly. In the interim, officials are emphasizing the non-digital entry points to their system, including the ability to call in or send a paper application. That's not, however, a substitute for making their website work.

The administration still has time to do that. Although only 14 percent of adults say they have already visited one of the exchange websites, an additional 23 percent say they think they will do so in the next few months, according to a survey by the Pew Research Center conducted Oct. 9 - 13. Those without health insurance are more likely than those with insurance to have already visited (22 percent vs. 12 percent) or to plan to do so (42 percent vs. 19 percent) in the coming months.

The question is, at what point will a dysfunctional website impede the law's ability to function? White House officials didn't have a target date for that but most experts point to some time around mid-November, or even Thanksgiving, as the crucial moment when the health insurance marketplace needs to be working.

"There are two campaigns," Kingsdale told me, "the enrollment campaign and the political campaign. October is obviously very big in the political campaign but it's not that big in the enrollment campaign. November is the month that's key."

On Monday I pressed administration officials for a concrete "drop-dead" date and they couldn't give me a time frame. Instead they pointed out the good that the law has done already, such as the fact that in the course of 17 days, 56,000 in Oregon have signed up for the health law's Medicaid expansion. "That number is going to dramatically increase over the course of the next six months," they added. It hasn't been a Whole Foods shopping experience; that much we know is true. The question now is what happens in a month.

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