WASHINGTON — For President Obama, the one "must read" from the latest Sunday papers is an essay in The Washington Post by Jon Kingsdale, who ran the health exchange for the Massachusetts program of mandatory insurance from 2006 until 2010.
Kingsdale — a backer of the Affordable Care Act, or "Obamacare"— thinks the administration faces lots more problems, even if the HealthCare.gov website is eventually up and running.
Kingsdale says that in Massachusetts, a reliable website was only a modest worry. Much harder was getting "enrollment, billing and premium collections working smoothly." Here's why:
"Enrollees are not covered until their first month's premium is received. In the individual insurance market, premium billing and collection [are] difficult to track.
Folks frequently pay late or in weekly installments, or send too little or even too much. And when they stop paying, they often do not notify the insurer; the company must determine whether it is an intentional termination, an oversight, or a lost or late payment. . . . if insurers cannot track and collect premium dollars each month, the extra work of doubling back with customers and insurers will frustrate consumers and delay coverage. And a mounting backlog could eventually compromise the fiscal integrity of the exchange."
Translation: Assuming the website is completely fixed, Obamacare's woes could still slow its introduction or, at worst, result in its collapse.
One danger for the administration, Kingsdale says, is much higher premiums. If people are frustrated in signing up or staying signed up — especially among so-called "young invincibles" whose premiums are supposed to subsidize older, sicker people — then insurance companies will raise premiums to cover costlier enrollees.
Higher premiums for 2015 (most rates are set for 2014) will become public next fall, just weeks before congressional elections, Kingsdale notes. Obama's greatest legislative triumph could backfire big time.
Without intending it, Kingsdale has, I think, identified a central source of Obamacare's problems: The people who created the program had no idea of how it would be put into effect.
They just took it for granted that the law would be implemented and perform, more or less, as intended. This attitude blended carelessness, ignorance and arrogance, reflecting a broader problem in business and government.