In President Obama's Oct. 21 address on the Affordable Care Act and persistent enrollment glitches for the new marketplaces, it was tempting to say the White House gathered all the people for the Rose Garden speech (about 10) who successfully signed up through to stand behind the president.

In reality, a lot more people have hurdled the crashes and complexities of The federal website and state-run exchange websites have fielded about 500,000 applicants in the first three weeks. For all the glitches, many of the people who enrolled had to weather two or three attempts to get enrolled.

In a country with nanosecond attention spans, two attempts is often one too many, three weeks of glitches is a lifetime, and six months of open enrollment is an eternity.

Because the computer problems have endured, there is a tendency to think is sinking fast. Think of the website as a ship at sea. The hull hasn't been breached, but the engine needs work, so the Health & Human Services department will deploy sails and oars until the motor runs smoothly.

For exchanges, that means pushing hard for people to sign up by phone or even mail. Just this morning, an enroll by phone option popped onto the landing page. Those options take healthcare back to the pre-Internet days and will be cumbersome for people who want to sort through all the options. That President Obama was encouraging potential enrollees to use the telephone and paper applications may be a testament to just how complex the website problems are. But he wants them fixed them quickly. Nobody is madder than me that the website isn't working as it should, which means it is going to get fixed, Obama said during the address.

It's true that many new programs have rough starts, and October enrollment estimates won't necessarily predict the success of the exchanges over time. Nor do exchanges provide a full picture of the ACA's success. The president lauded Oregon's Medicaid enrollment (56,000 people in three weeks) while conveniently omitting details on the CoverOregon website, which hasn't enrolled anyone due to its own technical problems. But Medicaid has been an early driver, especially among the younger uninsured. The product is working. It turns out there is massive demand for it, Obama said, noting that the ACA has eliminated once-cumbersome parts of enrolling for health coverage, including questionnaires and medical histories.

What also goes unspoken is that HHS probably never anticipated that 30-plus states would pass on operating their own exchanges. Uninsured populations from four large states with federal exchanges - Texas, Pennsylvania, Michigan and Florida - could have crashed the site on their own.

As the contractors work to fix the problems with, they might rely on the designs that have worked relatively well in some state-run versions. But the web designers fixing the glitches should not drag their feet. If the president has to talk about website troubles again in November or December, then it might be time to worry about's viability.

Follow Bill Melville on Twitter @BillMelvilleHLI

DRG becomes Clarivate

View Now