As the House of Representatives prepares to sue the President for "unprecedented abuse of power" in his management of the ACA, a quick comparison with Medicare D hobbles the charge.
Yes, the ACA Rollout was messy as were efforts to deal with early glitches-
a) Website malfunctions and the failure to function at all produced bad enrollment numbers and bad enrollee data.
b) Consumers were struck by the narrow networks of insurers as most companies stood off to the side awaiting the results of first trials.
c) There was general confusion over the implementation of the law.
d) When the president moved to extend several key deadlines and make a number of program adjustments, he was loudly criticized (and now the subject of a lawsuit and threats of impeachment) for taking unilateral executive action.
The Bush administration encountered these exact same problems in implementing Medicare Part D, the prescription drug program for Medicare recipients.
Of course, the program was much smaller in scope than the Affordable Care Act But a Congressional Research Service Report on the implementation of Medicare Part D dated Feb. 6, 2006, shows remarkable similarities.
Below are a few highlights, with quotes from the report in italics.
A) The Website did not work. The cornerstone of the site, the Medicare Prescription Drug Plan Finder, which was supposed to be up and running on October 1, 2005 was initially delayed until October 13 for "technical reasons" and delayed until October 14 "because of Yom Kippur." But, nothing happened. On October 23, Mark B. McClellan, head of the Centers for Medicare and Medicaid Services told reporters that the feature definitely would be ready before Nov. 15, the date when seniors were supposed to begin signing up for the drug benefit. But the tool failed to work and would not work properly for another two months!
Phone bank backup failed time after time at both the federal level and in banks set up by insurance companies. Busy signals, very long waits, dropped calls and misinformed operators plagued the efforts. Government Accountability Office investigators said that Medicare telephone operators routinely failed to give accurate information. There were also detected problems on the government's Web site and in handbooks.
The E1 Eligibility Verification System was down more than it was up In the first three months its failure rate was over 50 percent and even when it worked there were slow response time to queries submitted by pharmacies and/or transactions being stopped due to the length of the processing time which affected 2/3 of all requests. E1 queries tended to provide incomplete or inaccurate information about which plan an individual was enrolled in and how much an individual was required to pay for cost-sharing resulting in interruptions of services.
B) The transfer of the dual eligibles from Medicaid to Medicare drug coverage on January 1, 2006 was delayed by six months for many of the program recipients resulting in critical gaps in prescription services (i.e. old people did not get their meds!).
C) Many recipients were surprised by the smaller networks or overwhelmed by ridiculously large ones. For those who had been covered by Medicaid nearly 20 percent of their drugs were no longer covered by the PDP's to which they were assigned. For those who were more affluent there were so many plans to choose from that many were overwhelmed and failed to sign up in time. David Brailer, the first National Coordinator for Health Information Technology, told Congress that both problems were the result of holes in the system that presidential action fixed.
D) More than a dozen procedural fixes were put in place under presidential authority and a half dozen key deadlines were moved. In May of 2006, just days before the May 15 deadline ending open enrollment, President Bush took administrative action to waive “penalty fees for very low-income seniors and people with disabilities who sign up late” and allowed “the same impoverished beneficiaries to sign up for Medicare drug coverage until Dec. 31.” Protests for senior advocacy groups following this led to a general expansion of the window to September 30.
“In other words, you can apply after May 15th without penalty,” Bush told seniors during an event in Florida. “And that’s important for low-income seniors to understand.”
Another very significant calendar requirement change was made when, under executive order, when the implementation time for an enrollment to become effective was changed from 30 to 90 days at the request of prescription providers.
E) Signups were disappointingly small. As of May 15, 2006, the original deadline, only10 million of the 16 million needed to meet the Phase One goal.
F) Part D was not popular. 21 percent of the public (per Gallup) had a favorable opinion of the program in April 2005. By May of 2006 the number was down to 21 percent. Kaiser reported that only 27 percent understood the law on the eve of its implementation.
G) When Medicare Part D faced early troubles, many states, mostly Blue, came to its rescue. The New York Times reported in 2006 that "about 20 states, including California, Illinois, Ohio, Pennsylvania and all of New England, have announced that they will help low-income people by paying drug claims that should have been paid by the federal Medicare program."
H) There were 7 Congressional fixes to the Medicare Prescription Drug, Improvement, and Modernization Act in the first six months of the program. Since the original bill had passed by only one vote in the House and required major negotiation in the Senate to even get to the floor, Congressional cooperation with fixing problems is interesting when compared to the ongoing GOP opposition to ACA. One other interesting comparison. The first Congressional hearings on ACA took place 10 days after the Marketplace opened. The first Congressional hearings on Medicare D took place 5 months after signups began.
I) Despite the many parallels between the rollout of Medicare Part D and the Affordable Care Act, there was one obvious difference. Democrats were far more supportive of President George W. Bush’s effort than Republicans have been of President Barack Obama’s. These comments were typical.
"I voted against it, but once it passed I certainly determined that I would try to do everything I could to make sure that New Yorkers understood it, could access it, and make the best of it." Sen. Hillary Clinton (D-N.Y.)
"We need to put aside any partisan thoughts to work together to get this program running so that seniors are better off than they were before we passed the drug benefit. I do not believe we are there at this time." Sen. Herb Kohl (D-Wis.)
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Postscript courtesy of DK diarist snapples:
An article on exactly why Boehner's law suit has NO merit and will flop in spectacular fashion. Summary: There was no harm. 95% of the eligiblecompanies w/ over 50 employees already had insurance. No one was hurt by the mandate.