The administration's announcement on Friday that it was delaying the enrollment deadline to sign up for health insurance by eight days is at least the eighth announced delay in implementing the Affordable Care Act since the summer.
If you thought that the argument over delaying implementation of the final major phase of ACA broke down across partisan lines, with Republicans calling for delay and Democrats resisting, think again. The White House has long acknowledged that a law this complex would normally require a package of legislative fixes as implementation proceeded. But with House Republicans fixated on repealing the law, the administration saw no way to legislatively address problems that have arisen since the 2010 midterms without opening up the possibility of the entire project coming undone.
Most recently, Republicans pressed to delay the rollout of the final major phase of the law until after the 2014 midterm elections, in hopes that the GOP could retake the Senate and finally repeal the law before a wave of changes created facts on the ground. The administration fought off this bid for a delay and blocked GOP efforts to defund implementation of the law in toto, but not before the impasse had led to the government shutdown, which began October 1—the same day as open enrollment in the exchanges.
The shutdown was more the result of the administration trying to defend the very existence of the law and how it would remake the health-insurance environment than it was a sign of certainty that everything was on track. Already by the time of the shutdown, executive-branch officials had announced delays to significant parts of the ACA rollout.
Here are eight of the delays in parts of the ACA announced by the administration since the summer:
1. Enrollment-Deadline Delay: On November 22, the Department of Health and Human Services announced the deadline to enroll for January 1 coverage had been pushed back from December 15 to December 23.
Result: People who are currently insured but whose plans are being cancelled will have another full week to try to get coverage through the improved Healthcare.gov or other sites. That lowers the odds that that they will become uninsured en masse in January if there's not enough time to get new insurance through a functional exchange before their old plans lapse.
2. 2015 Open-Enrollment Delay: On November 21, the administration pushed back the start of open enrollment for 2015 from October 15 to November 15, 2014, avowedly for technical reasons though with some pretty handy political results, too.
Result: The delay guarantees there will be no new website snafus right before the November 4 midterm elections. Insurance rates for 2015 will still have to be set before the midterms so they can be approved by insurance commissioners, but the delay reduces the risk that regular people will encounter rate shocks and technical glitches right before they cast their ballots, as customers paw through websites looking at their 2015 options. As well, every year after this first one, insurers offering plans through the exchanges are supposed to have nine months between open-enrollment periods to sort out who's in their risk pools and what they want to offer the following year. This year they only had six months because of the unusually long initial open-enrollment period. Delaying 2015 open enrollment will give them seven months in the first year instead of nine. It would seem to open up some room to extend first-year open enrollment for a month beyond March 2014, too—something many red-state Democrats have requested.
3. Effective Tax-Penalty Delay: In late October, officials announced they were effectively delaying the imposition of the tax penalty for being uninsured. People who purchase insurance during the final month and a half of the open-enrollment period, which ends March 31, will no longer be at risk of having to pay a fee even though they followed the rules.
Result: Because of a timing mismatch, there was a risk that a user could buy insurance between February 15 and the end of open enrollment, but their insurance wouldn't actually become effective until April 1 or later—more than three months into the year. Anyone who's uninsured for more than three months is supposed to be slapped with a tax penalty, so a user could have done everything right in signing up and still end up with a gap of more than three months and a tax bill. This would have discouraged sign-ups right before the March deadline, when enrollment in ACA plans is otherwise be expected to be at its highest. The administrative fix put the two deadlines in sync.
4. Large-Employer-Mandate Delay: In July 2013, the administration announced it was delaying by a year the rule that that large employers must provide full-time workers with insurance.
Result: This delay makes life easier for large companies, the administration, and the IRS. Oh—and it will cost the government somewhere around $11 billion in lost penalty revenue. But the reality is that vast majority of large employers—those with more than 50 full-time staffers—are already providing health insurance coverage to their employees. The real employer-insurance gap is among small businesses.
5. Small-Business-Site Delay: Right before Healthcare.gov went live, the administration announced that online enrollment through the federal site for small businesses to shop for insurance would be delayed for a month. At the end of October, health officials announced the delay would be extended until late November.
Result: Small-business owners who were uninsured or individually insured have been significantly delayed in their ability to set up a group plan for their employees that starts January 1. The same goes for the employees, who might otherwise have been expecting coverage through employers rather than having to go into the individual market themselves.
6. Back-End System Build-out Delay: The mechanism for transferring subsidies from the federal government to insurers through Healthcare.gov has yet to come online. It was revealed during a House hearing last week that 30-40 percent of this "back-office" system has yet to be built.
Result: Given that the public didn't even know about this until mid-November, it is unclear what the impact will be. Since there is one more part of the Healthcare.gov apparatus that remains to be built, there is one more opportunity for something to go awry with a critical part of the government-run website. If there's a silver lining for the administration, it's that the victim of any flaw will be insurers who are getting stiffed, not consumers.
7. Spanish-Language-Site Delay: The administration said in late September that the Spanish-language version of Healthcare.gov would be delayed until mid-October. In late October it announced an indefinite delay in building enrollment functionality into the site.
Result: People who prefer to use Spanish for complex tasks such as signing up for health insurance have to find ACA navigators or call the 800 number instead. The site CuidadodeSalud.gov is live but not capable of processing enrollments.
8. Healthcare.gov Functionality Delay: Last, and assuredly not least, there has been a two-month delay in the functional launch of the federally-run website for enrolling people in insurance plans in 36 states. This delay was announced on October 25, weeks after the website went live.
Result: President Obama's poll numbers have cratered, most consumers who have tried the site have had negative experiences with it, early enrollment through the site has been low, and major questions have been raised about the U.S. government's capacity to manage any major new project.