It's easy to think of the launch of the Affordable Care Act, or Obamacare, as just one big disaster. But in reality, there has been a rolling series of compromises, unfinished work and shifting deadlines as the White House rushed to begin enrolling people into health care.
In fairness to the beleaguered Obama administration, things seem to be running more smoothly now, if still not perfectly. Standing up the biggest social program since President Lyndon Johnson's Great Society is a tough task. It wasn't made easier by a hard-fought Supreme Court challenge, or by states refusing to help -- and even working to hurt -- the law, or by Congress' refusal to pay for it.
"Reform the health care system, they said. It'll be great, they said. &^$*#!"
So provisions were delayed. Benefits were postponed. Corners were cut. Here are some of the biggest examples of Obamacare being rewritten on the fly in the 44 months since President Barack Obama signed it into law.
October 2011: CLASS Act Dismissed
The late Sen. Edward Kennedy (D-Mass.) pushed for years to get a program in place that would help the elderly and people with disabilities pay for long-term care services and supplies not covered by insurance or Medicare. Though Kennedy didn't live to see it, his dream became part of the ACA in the form of something called the Community Living Assistance Services and Supports Act, or CLASS Act. But the math never really made sense, and Health and Human Services Secretary Kathleen Sebelius was forced to admit the program wouldn't be fiscally sustainable, so she pulled the plug. Congress made it official by repealing the CLASS Act in February 2013.
February 2013: Some Out-Of-Pocket Cost Caps Postponed Until 2015
February 2013: High-Risk Pools Enrollment Halted
Unlike Obamacare's high-risk pools, this pool is open. But ew.
This experiment in so-called high-risk pools -- one of many Republican ideas crammed into the ACA in a vain hope of attracting bipartisan support -- had problems more or less from the beginning. The Pre-Existing Condition Insurance Plan, designed as an insurer-of-last-resort for people with serious ailments or histories of high medical needs, failed to attract as many people as hoped, and still was on track to run out of money way ahead of schedule before they closed it off to new members.
February 2013: No Basic Health Plan Until 2015
I fought my liberal heart out for universal health care and all I got was this lousy cap. And a tax credit.
The basic health plan is a sop to progressives, who didn't get the single-payer plan they wanted, or even a debate on it, when Congress considered the ACA in 2009 and 2010. They didn't even get any of the roughly 10,000 iterations of a public option that floated around Capitol Hill during that time. This small consolation prize, state-run insurance plans for low-income people who earn too much for Medicaid but may find private coverage too costly, won't be available until 2015 at the earliest.
July 2013: Income-Verification For Government Assistance Scaled Back
July 2013: Employer Mandate Postponed One Year
This guy ALWAYS gets what he wants.
This one was a real doozy. Big businesses whined about the onerous paperwork required to keep track of how many workers they employed, who was full-time, who was part-time, and how many were enrolled in a company health plan, so the administration put it off for a year, along with the penalties firms would owe for not covering workers. It wasn't much of a coincidence that some high-profile companies like SeaWorld and White Castle started cutting back employees' hours to keep them below the 30-hour threshold that obliged companies to cover them or pay fines. And this delay gave the GOP plenty of ammunition to argue that everyone should get their own personal Obamacare delay.
August 2013: Congress Get Its Health Benefits Paid For After All
October 2013: Applying For Benefits Directly Through Insurers Delayed
The ACA expected some people would rather skip the exchanges and go straight to an insurance company or online broker. It was supposed to let consumers apply for tax credits through these private companies. But, except for a small pilot program, it's still not an option for most consumers who qualify for help because -- wait for it -- the technology isn't working right.
"Let's see... Health Care dot Gov! Okay, now I'll just -- akdnufweuiudsnkjdsfjhfhjk!!!"
Unlike other items on this list, the initial failure of HealthCare.gov wasn't a deliberate delay, just a screwup. But launching a website that only let six people actually enroll on the day it debuted and was mostly inoperable for almost two months afterward is pretty much the same as delaying the website's launch, just in a way annoying to far more people. The administration unofficially relaunched the website on Dec. 1, and it seems to be a lot better. So far.
November 2013: Small-Business Online Enrollment Delayed Until 2015
Area tavern owner is disappointed.
The ACA created insurance exchanges for small companies that aim to level the playing field with larger businesses, by letting the little guys buy coverage from a larger pool, choose between many competing insurers, and tap into new tax benefits. But there's one thing small companies won't be able to do for 2014 health benefits: shop online using the federal exchanges. That's been pushed back a year. Oh, and in April, the administration put off a key feature of the small-business exchanges: employees being able to pick their own plans.
November 2013: White House Gives Shoppers Extra Time To Buy New Insurance Plans
November 2013: Obama Asks Health Insurers To Renew Canceled Plans
Hey, what's everybody so darn upset about?
"If you like your plan, you can keep it!" "Okay, actually that's not technically true." "All right then -- state regulators and insurance companies, let people keep their plans even though I said they were terrible." "Oh, a lot of you don't want to do that?" "Um..."
November 2013: 2015 Insurance Enrollment Period Pushed Back A Month
October-December 2013: Spanish-Language Website Launch Delayed
«¡Gracias por su paciencia!»
¿No se puede? Not at first, anyway. The White House made a big deal about how CuidadoDeSalud.gov would let Spanish speakers have the same access to Obamacare as English speakers. It made a lot of sense to ease enrollment for Latinos, who are disproportionately uninsured and low-income. But Hispanohablantes had to wait until the English-language site was working better to even get access to online enrollment, putting this segment of the population even further behind the rest of the country when online sign-up became available in early December. Que triste.
December 2013: A Temporary Program To Insure People With Pre-Existing Conditions Is Extended By A Month
December 2013: Window-Shopping Available On HealthCare.gov, Two Months Late
This poor guy just wants to know how much his health insurance costs.
HealthCare.gov -- the federal portal for insurance-shopping under Obamacare -- launched, and basically crashed, on Oct. 1. Its first problem seemed to be that it made users create an account before they could even browse insurance options, which created a bottleneck that snarled the computer systems. Since window-shopping is really all most people probably wanted to do at first, this was kind of a huge deal. State-run exchanges that let people window-shop had a generally smoother experience. Finally, in early December, window-shopping without an account appeared on HealthCare.gov. It's right on the front page and everything!
December 2013: Insurers Asked To Ease Deadlines For Customers
Little help here, guys?
December 2013-????: It's Anybody's Guess
"What if I mandated a one-year delay in anybody getting sick?"
With this kind of track record and the first year of Obamacare enrollment still kind of shaky despite some recent hopeful signs, what else might be delayed or pushed aside? The White House already has strongly signaled that anyone who winds up uninsured because the government failed to build a reliable enrollment system won't be subject to tax penalties for violating the individual mandate. And even though administration officials say time and time again that they won't extend this year's enrollment period past March 31, well, a lot of things that weren't supposed to be delayed already have been.