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Krugman: Looking for where reform works? Try California

  • Clay Bennett, Chattanooga Times Free Press

It goes without saying that the rollout of Obamacare was an epic disaster. But what kind of disaster was it? Was it a failure of management, messing up the initial implementation of a fundamentally sound policy? Or was it a demonstration that the Affordable Care Act is inherently unworkable?

We know what each side of the partisan divide wants you to believe. The Obama administration is telling the public that everything will eventually be fixed and is urging congressional Democrats to keep their nerve. Republicans, on the other hand, are declaring the program an irredeemable failure, which must be scrapped and replaced with . . . well, they don't really want to replace it with anything.

At a time like this, you really want a controlled experiment. What would happen if we unveiled a program that looked like Obamacare, in a place that looked like America, but with competent project management that produced a working website? Well, your wish is granted. Ladies and gentlemen, I give you California.

Now, California isn't the only place where Obamacare is looking pretty good. A number of states that are running their own online health exchanges instead of relying on HealthCare.gov are doing well. Kentucky's Kynect is a huge success; so is Access Health CT in Connecticut. New York is doing OK. And we shouldn't forget that Massachusetts has had an Obamacare-like program since 2006, put into effect by a guy named Mitt Romney.

California is, however, an especially useful test case. First of all, it's huge: If a system can work for 38 million people, it can work for America as a whole. Also, it's hard to argue that California has had any special advantages other than that of having a government that actually wants to help the uninsured.

When Massachusetts put Romneycare into effect, it already had a relatively low number of uninsured residents. California, however, came into health reform with 22 percent of its nonelderly population uninsured, compared with a national average of 18 percent.

Finally, the California authorities have been especially forthcoming with data tracking the progress of enrollment. And the numbers are increasingly encouraging. For one thing, enrollment is surging. At this point, more than 10,000 applications are being completed per day, putting the state well on track to meet its overall targets for 2014 coverage. Just imagine, by the way, how different press coverage would be right now if Obama officials had produced a comparable success, and around 100,000 people a day were signing up nationwide.

Equally important is the information on who is enrolling. To work as planned, health reform has to produce a balanced risk pool — that is, it must sign up young, healthy Americans as well as their older, less healthy compatriots. And so far, so good: In October, 22.5 percent of California enrollees were between the ages of 18 and 34, slightly above that group's share of the population.

What we have in California, then, is a proof of concept. Yes, Obamacare is workable — in fact, done right, it works just fine.

The bad news, of course, is that most Americans aren't lucky enough to live in states in which Obamacare has, in fact, been done right. They're stuck either with HealthCare.gov or with one of the state exchanges, like Oregon's, that have similar or worse problems.


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