Crisis Averted for Medicare and Medicaid. Not So for ObamaCare.

So, just hours from national debt default last night, a deal was struck to reopen the government and raise the debt ceiling.  Our long national nightmare is over…at least until January 15, when this entire calamity could be repeated by battered ObamaCare dead-enders.  It’s a crisis averted for Medicare and Medicaid, but not so for ObamaCare.

As hundreds of thousands of Feds returned to work here in DC this morning, the overwhelming question on the street was, “Wait, what the hell was this for anyway?” (And, “is the PandaCam back on yet?”)

You’ll recall this episode was caused by Congressional right-wingers led by Senator Ted Cruz (R-TX) forcing a shutdown to defund ObamaCare.  Didn’t happen, never could have happened.  Anyone who’s watched the famous “School House Rock” episode “I’m Just a Bill” knew that.  In the end, the anti-ObamaCare fanatics got nothing.  Not one concession.  Instead, the Cruzers managed to distract the entire country and the press from the colossal mess that is the launch of the health insurance exchanges. Oh, wait, his 21-hour filibuster and shutdown antics actually did some good: Cruz himself raised over $800,000 in campaign contributions in the third quarter alone.  While conservatives promised not to repeat the economic hostage-taking in January when government funding next expires, that kind of cash-for-obstructionism pays and we’ll have to see. It will coincide with the now-all-important effective date of ObamaCare coverage on January 1, and may be too much for the Cruz faction to pass up. In the meantime, the ObamaCare Funhouse is open!

With the shutdown in the rearview mirror it’s time for oversight hearing Palooza — and a press refocused on the messy launch of the exchanges.  Every House committee with any healthcare jurisdiction is already calling for hearings.  Some of the best reporting I’ve seen in years is happening as a rolling whodunit of finger-pointing.  If Health and Human Services Secretary Kathleen Sebelius keeps her job in the face of this epic mess she’s going to need her own parking space on the House side.  Despite calls for her sacrifice, I think she’ll keep her job, as will CMS Administrator Marilyn Tavenner.  If for no other reason, the White House knows they’d never get replacements through Senate confirmation hearings in this environment.

To date, healthcare.gov has had some 15 million visitors, but it appears some 150,000, less than 1%, have been able to enroll given persistent technological snags.  Indications this week are that the consumer experience with ObamaCare is improving as CMS and its array of contractors work around the clock debugging and finding workarounds. But the fixes aren’t coming fast enough to avoid a whirlwind of scrutiny in the weeks ahead from restive Republicans looking for blood and the ultimate “afflict the comfortable and comfort the afflicted” story for journalists.  Four major areas will be probed in the coming weeks:

• The Technological Meltdown: the GOP is already calling the ObamaCare exchange launch a “$400 million disaster” and the technological shortcomings have been well-reported.  As consumers manage to establish accounts, the next wave to hit ObamaCare will be harder: subsidy eligibility determination.  Health plans participating in the exchanges are seeing a trickle of “834” enrollment transactions come through.  It’s a small sample but thus far the quality of the data is as questionable as the rest of the launch.  This is now a footrace to December 15, the cutoff for January 1 effective enrollment; if widespread problems persist, it will become a serious liability for the Administration.
• The Traffic: healthcare.gov has had 15 million visitors thus far.  Last week it was learned that HHS estimated on September 5 that 500,000 would be signed up by October 31, and they’re clearly way, way behind.  But the stunner was the revelation that HHS built the website to handle 50,000 visitors an hour — in the face of 50 million uninsured Americans, sorry, but that’s like 1-800-FLOWERS being unprepared for Valentine’s Day.  The fanatics will have a field day with this one.  Democrats will push back that no one anticipated 36 states revolting and forcing the Federally-Facilitated Exchange to pick up the slack, and predictably, every time the Administration asked for more money, Congress refused.
• Fraud.  Republicans were already making hay of hacking and fraud concerns before the government even reopened.  It’s a simple enough question: “if the rest of ObamaCare’s functionality is so third world, how can consumers know their sensitive personal health information is safe?”
• The Guys Who Farted and Are Pointing at the Dog.  Lead healthcare.gov contractors like CGI Federal and QSSI are going to get Cruzified in the both hearings rooms and news stories in the weeks ahead.

So ObamaCare drama will intensify, just as Medicare and Medicaid temporarily ducked a bullet.  A shutdown of over 30 days — or worse, a debt-ceiling breach — could have been big trouble for our favorite health programs.  With CMS staffers back on the job, claims and payments will flow again, at least until January 15.  But the deal included establishment of a budget conference committee that’s supposed to look at the big picture of reining in entitlement programs, the biggest contributors to the national debt.  The consensus in town is that panel is DOA, on a road to nowhere, just like the Super-Committee of the last budget debacle, given the worsening political rift in DC.  And that means major reforms to Medicare and Medicaid are unlikely in the near future.  Some relief as the dust clears here in Dysfunction Central.

Resources:

Hear more of John’s predictions and analysis on how the political landscape impacts decision makers for Government-sponsored health care’s private partners.  Register for his complimentary November 19th Webinar

Podcast from John Gorman: What does the deal to re-open the government mean for Obamacare, Medicare and Medicaid?  Listen now

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