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Obamacare weathering the storm

The Obama administration is about to reach its self-imposed deadline to fix, and the White House appears set to claim victory.
Janelle Arevalo (R), an insurance agent with Sunshine Life and Health Advisors, makes a house call to sign up Sandra Berrios for an insurance plan under the Affordable Care Act on Nov. 14, 2013 in Miami, Fla.
Janelle Arevalo (R), an insurance agent with Sunshine Life and Health Advisors, makes a house call to sign up Sandra Berrios for an insurance plan under the Affordable Care Act on Nov. 14, 2013 in Miami, Fla.

The Obama administration is about to reach its self-imposed deadline to fix by the end of the month, and the White House appears set to claim victory -- at least a partial one.

The administration is expected to announce Sunday that the site will be functional for the vast majority of users. In other words, the public will be able to use a website that allows applicants to find subsidies they qualify for, compare private plans, and, ultimately, enroll.

There is still plenty of work to be done, and key questions about the site’s performance won’t be answered until traffic ramps up in the coming weeks. But 60 days since the health care exchanges debuted, the sense of crisis surrounding the Affordable Care Act (ACA)—driven by the twin challenges of a dysfunctional website and a flood of cancellation notices sent by insurers—is waning.

After weeks of intense work by a team of outside consultants on leave from Google and other major tech firms, the site’s capacity has been doubled to handle 50,000 simultaneous users, or up to 800,000 per day, the administration said this week.

That has already led to a boost in signups. Between Sunday and Tuesday, nearly 20,000 people—the most for a three-day period—successfully enrolled in the federal online exchanges, according to the New York Times. During the entire month of October, just 27,000 did so. The site has also seen major performance enhancements since its launch in October.

President Obama has said fixing the site is just one piece of improving the signup process. "Part of what we’re realizing is that they are going to be a certain portion of people who are just going to need more help and more handholding in the application process," he told reporters earlier this month. "And so I guess part of the continuous improvement that I’m looking at is not just a technical issue.  It’s also, can we streamline the application process? What are we doing to give people more assistance in the application process? How do the call centers and the people who are helping folks in-person -- how are they trained so that things can go more smoothly?"

Making it easier to sign up has emerged as the most pressing issue concerning the health care law. If it remains difficult, that could deter healthier Americans—whose participation is crucial if the exchanges are to work properly—from enrolling.

Work on was continuing over the weekend. Julie Bataille, spokesperson for the Centers for Medicare and Medicaid, issued a statement saying the site was "performing well" on Saturday "with low overall error rates and response times despite heavier than usual weekend traffic." 

"We are making additional hardware upgrades and software fixes [Saturday night] as part of a planned set of improvements to improve speed and reduce errors," she added.

But the exchanges aren’t out of the woods yet, and there are signs that the administration expects to see more bumps in the road.

For one thing, the rate of signups needs to pick up dramatically. Insurers have said that in order for the marketplace to work, 7 million people will need to sign up. At the current pace, just 1.1 million would do so by March through the federal exchanges, which cover two thirds of the population, according to the Times.

The White House said earlier this month that the goal was to have 80% of the site’s users complete the process by enrolling in a plan. But asked this week whether the administration was tracking that number and would release it, Jeff Zients, who is managing the website repair project, was evasive. "We will continue to update you on metrics and user experience and our success rates as we go forward," he said.

In another indicator that there is still less than total confidence in’s functionality, the administration has asked health-care advocacy groups that are helping people to enroll not to send a flood of applicants to the site next week. Instead, officials are requesting a more gradual approach.

And the administration announced last week that it would extend to Dec. 23 the deadline for people to sign up for plans that start on the first of the year, a concession to the difficulties that many users have had accessing the site. The administration has also delayed the online marketplace for small businesses by one year.

Still, there is plenty of good news emerging amid the law's rollout. The state-based exchanges are running smoothly and racking up solid numbers of enrollees—proof, supporters say, of the huge demand for affordable coverage, and of the law’s workability when state officials are cooperative. Kentucky’s exchange has emerged as the model, but California’s and New York’s are also success stories.

Ahead of the weekend deadline, the president sounded a confident note about the law's long-term prospects. 

“I continue to believe, and [I am] absolutely convinced, that at the end of the day, people are going to look back at the work we’ve done to make sure that in this country you don’t go bankrupt when you get sick, that families have that security,” Obama said in an interview Friday. “That is going be a legacy I am extraordinarily proud of.”

Secretary of State Kathleen Sebelius has echoed that optimism. “We are definitely on track to have a significantly different user experience by the end of this month,” she said in a conference call with state and local officials Tuesday. Still, in a blog post Friday at The Huffington Post, Sebelius urged users to visit during "off-peak hours"—an apparent effort to avoid overloading the site.

The law also appears to be succeeding in another key area: holding down health care costs. Since 2010, when Obamacare was passed, health spending has risen less than one-third as fast as its long-term average, after being adjusted for inflation, according to a White House report released this month. And there’s reason to believe the health care law has played a key role, in part through a provision that reduces Medicare overpayments.

It’s enough to make some Affordable Care Act supporters sound positively giddy.

“You won’t hear much about this good news until and unless the Obamacare website gets fixed,” economist and New York Times columnist Paul Krugman wrote Friday. “But under the surface, health reform is starting to look like a bigger success than even its most ardent advocates expected.”