But instead the administration is disinvesting to such a degree that the only logical outcome will be a decrease in enrollment and a skewing of the participant pool toward costlier, sicker people. This means higher premiums and insurers leaving the marketplace—facts which Trump recites enthusiastically at his rallies. The more people who miss the deadline, the more end up using emergency departments as primary-care offices.
Officials from HHS responded to my inquiry as to why the changes to enrollment are happening with a link to a vague statement, and they’ve been similarly unclear in anonymous press briefings. In at least one of these briefings, they asked to be referred to as “Health and Human Service Officials one, two, and three.” Centers for Medicare and Medicaid Services spokesperson Nicole Black responded to me with a short email that included the following unattributed quote, which she said can be credited to “a CMS spokesperson”: “Maintenance outages are regularly scheduled on HealthCare.gov every year during open enrollment. This year is no different.” (We didn’t agree beforehand that I would withhold names or receive information “on background,” a term which typically means a journalist won’t directly cite the source of information.)
This year does seem different. If the site is indeed down for hours on those five Sundays—outages that would make up 6 percent of the enrollment period—that would mean an increase from 0.1 percent downtime the year prior, according to a 2016 report to Congress by the U.S. Digital Service.
Black offered the caveat: “On background/not a direct quote: The duration of the outages that were listed in the notice are the maximum amount of time allowed for the maintenance; actual outage times could be shorter.” I said it would look strange to attribute a quote like that to an anonymous source and asked if anyone in the department could put their name on it, since it’s not a guarantee of anything. She said no.
The implicit philosophy conveyed by the changes so far is consistent with the lack of transparency in conveying them. And both seem designed to shore up the insistence by the president on many occasions that Obamacare is “failing,” and that “the best thing politically is to let Obamacare explode.”
(In that spirit, other changes could include HealthCare.gov changing its font to Wingdings. On Wednesdays and every other Thursday, it could be accessible only to people named Dave. HealthCare.gov could be outfitted with “retro 2013 functionality.”)
With Graham-Cassidy defeated, the administration does have the option to change its tack, acknowledge defeat, and unify to optimize the health-care system by getting people enrolled and making the law work. Though this would likely involve finding new ways of financing Republican reelection campaigns. The president indicated no such pivot this week, insisting that the law would be repealed. And in their concession statement on Tuesday, the authors of Graham-Cassidy said, “For the American people, when it comes to Obamacare, the worst is yet to come.”