As you may have heard, Healthcare.gov, the online insurance marketplace established under Obamacare, is having some trouble. The Washington Post reported Monday that tests conducted days before the site went live foreshadowed its current paralysis, while contractors predict it will be weeks before they can fully repair the system. As many as 5 million lines of code may have to be rewritten.
These are significant issues: without a functional web portal, people in more than half the states won’t be able to sign up for insurance. Why the site is such a mess is certainly an interesting story. But the sudden media swarm from the right and the left seems out of proportion, since practical and political repercussions will be minimal unless the site’s troubles fully wreck the rollout, which won’t be clear for several weeks.
The persistence of ideologically driven challenges to the healthcare law at the state level is more likely to keep millions uninsured. Healthcare.gov’s problems—and their solutions—are technical, not political. They may reflect unreadiness and even incompetence, but not cruelty and dishonesty.
Resistance to the expansion of Medicaid falls into that second category. Two-thirds of low-income blacks and single mothers, along with more than half of uninsured, low-wage workers, are likely to remain uninsured because they live in one of the states that have declined to expand the program.
Conservative groups like Americans for Prosperity, flush with cash from the billionaire Koch brothers, are running an aggressive ground game against expansion in undecided states including Virginia, Louisiana, Michigan and Pennsylvania. They are punishing supportive Republican lawmakers with radio spots and mailers, and by contacting their constituents directly via phone or at their doors. The Koch-backed National Center for Policy Analysis sent a witness to testify against expansion at a hearing in Virginia this week, where Obamacare is a major point in the gubernatorial race.
The decision these undecided states make about Medicaid could shift the calculus in other Republican-controlled states, even those that have already decided not to expand the program. Already there are signs that conservative governors are re-evaluating their positions, compelled by financial incentives.
On Monday, Ohio became the fourth GOP-controlled state to expand the Medicaid program. In a direct rebuttal of his fellow Republicans in the state legislature, governor John Kasich asked a state board that oversees adjustments in the budget to accept $2.5 billion in new Medicaid funds. The board voted to do so, extending eligibility to 275,000 adults. The conservative Buckeye Institute and the 1851 Center for Constitutional Law immediately declared that they would challenge the board’s jurisdiction in court.