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Accessible? Not yet

“The Health Insurance Marketplace is Open!” the home page on the Health Care.gov website breezily announces, but for most of the 14.6 million people who have tried to log in over the last two weeks, that promise proved a chimera. Computer problems caused by a perfect storm of complexity, inadequacy, and opposition have plagued the rollout of the Affordable Care Act.

It’s not as if there were no forecasts of impending disaster. The New York Times reported that “deadline after deadline was missed.” For example, the law was signed in March 2010. Health and Human Services officials awarded a contract to CGI Federal (the largest of the approximately 55 software companies working on the project) in December 2011. But the company did not get the information from HHS needed to begin writing code until this past spring. Even as late as September, officials were haggling over whether website visitors should be able to browse basic information without logging in.

Over the last 10 months, while HHS Secretary Kathleen Sibelius continued insisting that all was well, senior officials in HHS were privately and repeatedly expressing concern that the program was not at all on track. The complexity of the law itself created a mountain of regulations requiring programming. The decision to make the Centers for Medicare and Medicaid responsible for integrating all of the work of the various contractors (instead of making this the work of the main contractor) added both delays and difficulties. And some blame problems with the overall federal IT process for keeping the brightest minds from bidding on the projects.

Politics, of course, bears part of the blame: Opposition to the law was so heated that the administration delayed some regulations needed by software programmers until after the November 2012 elections. Thirty-six states, more than the administration had anticipated, opted to utilize the federal exchanges rather than creating their own, overwhelming the system. Despite clear indications of problems, delay of the individual mandate was not considered an option: According to the NY Times, “the White House, which was calling the shots, feared that any backtracking would further embolden Republican critics who were trying to repeal the health care law.”

That’s part of the fallout of our divisive politics, the fruit of the contention with which the law was mustered through Congress to begin with. Regardless, the 30 million or so uninsured people in this country don’t care how the sausage is made, they just want it to be edible. Government dysfunction on any level is unfair to them, and should be unacceptable to the rest of us.

All is not lost: Programmers and other experts are working hard to fix the site, and consumers still have time to sign up before the Jan. 1 deadline. Some state exchanges are working reasonably well—California enrolled about 29,000 people the first week and 27,000 more applications from the second week were pending. Commendably, some supporters have volunteered as navigators to help others through the system.

Hopefully, the storm clouds will clear and there will be bright days ahead for the ACA. In the meantime, prepare to be persistent when logging in to Health Care.gov.

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