Smart. Sharp. Funny. Fearless.
Thursday, June 21, 2018


It’s nearly impossible to overstate how awful the rollout of the Affordable Care Act (ACA) health insurance exchanges has been.

If you’re in need of an example, look to Oregon — a state that essentially did everything right.

The Beaver State expanded Medicaid to those earning up to 138 percent of the poverty level — a decision that’s already helped the state reduce its uninsured population by more than 10 percent — and they built their own exchange, as the law intended. And how many Oregonians has the online exchange signed up?


“The state has resorted to hiring or reassigning 400 people to process insurance applications by hand,” The Associated Press’ Jonathan J. Cooper reports.

This helps explain why liberal hero Senator Jeff Merkley (D-OR) is co-sponsoring a bill that would let those who have had their insurance canceled keep their plans, even though experts say such legislation would dull the effects of reform and possibly end up raising premiums.

The disastrous launch of the exchanges should have been easy to predict in retrospect. Federal and state governments are notoriously bad at information technology, Republican states rejected building their exchanges as part of a conspiracy to undo the law and any problem with the sites was bound to be fodder for a right wing set on destroying the law.

Perhaps the administration had been lulled into complacency by the seamless rollout of the law’s initial benefits. The Medicare donut hole closed, approximately three million children and young adults were allowed to stay on their parents’ insurance until age 26, free preventive care was added to every plan in the nation. All of these things went into effect without any evident drama. Or maybe they just had too much faith in their competence. Regardless, they’re in a mess that only they can get themselves out of.

Emboldened Republicans are certain that furor about cancelations will be followed by a furor about premiums, then people losing their doctors, though there’s not much evidence that rate shock will be widespread or the vast majority of insured Americans will see any noticeable difference to their care at all. Still, the right-wing attack machine is preparing to make sure the media focuses on the negatives of the law. And right now, that isn’t a difficult task.

Soon, if the exchanges can begin to function the way California’s already is, the benefits of the law and the way it has already transformed America’s health care system will be more obvious. Until that happens, here’s a reminder of five ways Obamacare is already changing America’s health care system for the better.