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Democrats are pleading for patience as they try to reassure the country that the online insurance marketplaces critical to President Barack Obama’s health care overhaul can be fixed.
Big programs have seen rocky rollouts only to achieve success later, they say. Their top example: the 2005 launch of Medicare Part D, President George W. Bush’s prescription drug benefit plan.
"Things went wrong with the Medicare prescription D plan that George Bush rolled out," Rep. Steve Israel, D-N.Y., told MSNBC on Nov. 6. "When things go wrong, there are two things we can do as a country. We can spend all our time figuring out who to blame, or we can spend all our time figuring out how to fix it."
Eight years after it went live, Medicare Part D is now widely popular among the seniors who use it.
Were there major problems with the rollout of Medicare Part D? And were they comparable to the challenges facing Obamacare? We decided to take a more a detailed look at its implementation.
Let’s play a quick game: who made this statement?
"This is a huge undertaking and there are going to be glitches. My goal is the same as yours: Get rid of the glitches."
A Democrat in 2013? Wrong! Actually, it was Rep. Joe Barton, a Texas Republican who chaired the House Energy and Commerce Committee, about Medicare Part D in 2006.
The similarities between the two health care programs, both heralded as the signature domestic achievements of the presidents who signed them into law, are at times eerie. Supporters of the laws asked for time and promised a quick fix. Critics did not mince their words. Even the lingo -- words like "glitches" -- has been recycled.
A report documenting the history of Medicare Part D was released earlier this year by a group of health policy experts at the Center on Health Insurance Reform at Georgetown University. It highlighted several areas where Medicare Part D struggled in its implementation that sound extremely familiar.
For one thing, the Bush administration faced a difficult political battle to get the bill passed in 2003. That damaged public opinion of the law, making it a challenge to educate 43 million seniors on its nuances.
Enrollment in the law was set to begin in late 2005. In April of that year, a Kaiser Family Foundation poll found that only 27 percent of respondents understood the law, while only 21 percent favored it. (In a comparable Kaiser poll in April 2013, 35 percent viewed the Affordable Care Act favorably and less than half felt they were well-informed of its details.)
The Medicare site, meant to help seniors pick benefit plans, was supposed to debut Oct. 13, 2005, but it didn’t go live until weeks later in November. Even then, "the tool itself appeared to be in need of fixing," the Washington Post reported at the time.
"Visitors to the site could not access it for most of the first two hours. When it finally did come up around 5 p.m., it operated awfully slowly," the Post reported. (Sensing a pattern?)
Once seniors began to enroll, problems persisted. According to the report, the online tools had "accuracy problems," and local organizations designated with assisting seniors "reported problems getting necessary and accurate information." Call centers provided by the Center for Medicare and Medicaid Services underestimated "the needed capacity to ensure that reliable answers could be provided" and "service representatives were not knowledgeable or failed to provide accurate information."
The Georgetown experts anticipated similar hiccups with the Affordable Care Act, noting that the country’s experience with Medicare Part D suggested "the experience will be far from perfect" and "problems were not always addressed as quickly or as thoroughly as critics would have liked, but fixes were usually found."
These days, nine in 10 seniors who utilize the program report they are satisfied with it.
"There’s really a striking amount of similarity even though this time it’s a far larger and daunting task. It’s a fair comparison," said Jack Hoadley at the Georgetown University's Health Policy Institute and one of the authors of the study. "Once something works its way through the problems, you forget the problems."
But there are important differences between Medicare Part D and the Affordable Care Act that make the challenges facing the exchanges different.
Because it was aimed at seniors and e-commerce was still relatively young, Medicare.gov was not intended to be the main hub for people to purchase and review plans, said David Brailer, the first National Coordinator for Health Information Technology under Bush.
"The issue with Medicare Part D is there were choices of 70 to 100 plans," Brailer said. "People were overwhelmed with the choices, with the options available and didn't know how to navigate and pick one. I don’t remember a conversation at all blaming any IT people. This was about how do you really navigate through all these choices."
Meanwhile, most people who logged on to healthcare.gov in the opening weeks couldn’t even get far enough to review what options were available.
Also, prescription drugs are a relatively small and easy-to-understand part of health care. Shopping for an insurance plan is more complicated.
"For those who did choose to enroll (in Medicare Part D) online, they checked out their options by typing in drugs they used, and once you did, you got an estimated out-of-pocket cost to make your comparisons. In the exchange world you have a full health care benefit to buy," Hoadley said. "The drug cost is relatively predictable, certainly a lot more predictable than overall health costs. The challenge for this website is a lot greater, probably by a significant amount of magnitude."
And there’s the political climate as well. When Medicare Part D passed, Democrats were not happy with the final bill and were critical of its botched rollout. But even then, they were generally supportive of its intended outcome and worked with constituents who had difficulty signing up or utilizing their new benefits.
When Medicare Part D faced early troubles, many blue states came to its rescue.
The New York Times reported in 2006 that "about 20 states, including California, Illinois, Ohio, Pennsylvania and all of New England, have announced that they will help low-income people by paying drug claims that should have been paid by the federal Medicare program."
By contrast, not a single Republican voted for the Affordable Care Act, and in the years since it passed, the party has made its repeal a top priority. In the states, many Republican governors have bucked the Medicaid expansion and rejected offers to build their own insurance marketplaces, putting greater pressure on the federal government.
Henry Aaron, a health policy expert at the Brookings Institute, said the opposition from Republicans has forced the Obama administration into a "two-front war" Bush did not have to fight.
"On the one hand, one must and should address the administrative problems that no one denies is plaguing the problem," he said. "But you’re also waging a war of public opinion against the hysterics of its critics."
Israel said, "Things went wrong with the Medicare prescription D plan that George Bush rolled out." There definitely were problems, and in some cases, the parallels between the prescription benefit program’s introduction and the Obamacare marketplaces are strikingly similar. While we also found some serious differences in the laws, we can’t find fault with Israel’s fairly general statement.
We rate his statement True.
MSNBC, interview with Rep. Steve Israel, Nov. 6, 2013
Rep. Joe Barton, Testimony during House Energy and Commerce Committee, Feb. 15, 2006
USA Today, "Poll: Medicare prescription drug program popular," Oct. 3, 2012
Florida Sun-Sentinel, "Crackdown on prescription drug imports seems fishy," Feb. 19, 2006
Washington Post, "Medicare Drug Plan finder: Still waiting," Nov. 8, 2005
Center on Health Insurance Reform at Georgetown University, "Launching the Medicare Part D Program: Lessons for the New Health Insurance Marketplaces," accessed Nov. 11, 2013
Phone interview with Jack Hoadley, Georgetown University's Health Policy Institute, Nov. 7, 2006
Phone interview with David Brailer, Managing Partner & CEO of Health Evolution Partners, Nov. 8, 2006
Senate Roll Call Vote on Medicare Prescription Drug, Improvement, and Modernization Act of 2003, Accessed Nov. 11, 2013
House Roll Call Vote on Medicare Prescription Drug, Improvement, and Modernization Act of 2003, Accessed Nov. 11, 2013
New York Times, "President tells insurers to aid ailing Medicare drug plan," Jan. 16, 2006
Phone interview with Henry Aaron, health policy expert at the Brookings Institute, Nov. 8, 2006
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