What Brookings Scholars are Saying about Affordable Care Act Implementation and

In remarks from the Rose Garden, President Obama acknowledged that the Affordable Care Act’s online portal,, “is not working the way it should for everybody—there’s no sugar-coating it.” A number of Brookings scholars have been commenting on various aspects of the Affordable Care Act (aka “Obamacare”) and its launch.

Henry Aaron writes that “Surprise at the glitches is unwarranted. Concern about design flaws is legitimate. The gloating is contemptible.” Noting the difficult roll out of the Medicare prescription drug program (Medicare Part D) in 2006, Aaron says that:

The U.S. health system is uniquely complicated. Because Congress decided to build on that system, rather than replace it with something simpler but more radical, complexity is inescapable and managing that complexity will strain administrative capacity. But it is a job we know can be done, because it has been done. And, when it is done, millions of previously uninsured Americans will enjoy access to health care and peace of mind that most Americans already enjoy and treasure.

Aaron told that “You can’t stand there with your green eyeshade on fixing computer code. You have to go out there and make the case to the American people.”

Larry Kocot, who worked on implantation of the Drug Plan Finder application of Medicare Part D, told Nextgov that “Politics has probably played more of a role in this than in any other rollout I’ve seen.” He added:

That probably made [agencies and contractors responsible for designing the system] more guarded about information they were willing to share. It probably resulted in a level of scrutiny of some decisions by career staff that otherwise may not have been as intense. It probably made them more aware of oversight. It probably hampered communication with other parties.

If something should be approved and it has a long line of other things that need to be approved behind it and it’s held up because somebody in a political position decided they needed to get very involved in the details and technical specifications — of something for which they may not arguably have had the right skill set, but they felt like they had to do it because of the political implications — that obviously slows down the process. And if one process is slowed down, others may be slowed down and that leaves to chance whether or not things are going to go as originally planned.

Keith Fontenot cautioned that we should “expect bumps” in the launch but “look down the road and judge success by how many people are enrolled and covered when you get into the next year.” Watch the discussion below:

Sheila Burke and Elaine Kamarck look beyond short-term implementation problems to detail 8 questions that are essential to measuring the success of the health care law. They also note the bumpy implementation of the Medicare benefit and the creation of the Department of Homeland Security.

Mark McClellan, a former chief of the Centers for Medicare & Medicaid Services, where he supervised implementation of the Medicare prescription drug benefit program, said “the administration still has some work ahead of them, but they do have time” but the real challenge is “can you work through these problems quickly?”

Get more coverage of what Brookings scholars have been saying about implementation of the Affordable Care Act