One problem is that too little money was budgeted for creating the exchanges, which are the online markets where people can choose among competing health plans and prices. It is also where those with income below a set ceiling—for example, up to $94,200 for a family of four—will be entitled to buy insurance at subsidized prices.
The Congressional Budget Office originally estimated that setting up the exchanges would cost between $5 billion and $10 billion. California alone is spending more than $900 million, yet the health-reform law allocated only $1 billion for the country as a whole. The Obama administration has been cannibalizing other federal health budgets in a mad rush to find more for the exchanges.
A second problem is complexity. The Obama administration wants something the federal government has never done: a computer system that connects HHS, the Internal Revenue Service, the Social Security Administration, Homeland Security and perhaps other departments. This is a herculean task with unclear benefits.