For all its expressions of confidence, the Obama administration has been unable to implement key elements of the law, including the employer mandate and its associated reporting requirements. By delaying those for a year, the president has set off a cascade of implementation problems — making the verification of eligibility for subsidies more difficult (and so proposing to give away billions in benefits on the honor system next year) and the confirmation of compliance with the individual mandate impossible.
Meanwhile, assurances about the quality of the state health-insurance exchanges have fallen by the wayside. (“Let’s just make sure it’s not a third-world experience,” one administration official told a health-industry gathering this spring.) And the promise that things won’t change for those who now have insurance is being abandoned. (“Depending on the plan you choose in the marketplace, you may be able to keep your current doctor,” a federal Web site assures visitors.) Perhaps most ominously, as information on state premium costs for 2014 trickles out, it seems likely these premiums will be too expensive to attract the large numbers of young and healthy people the system must have to function.