Searching for a cure

SOME day, Americans may be grateful for Barack Obama’s health reform. But not yet. Two numbers give Democrats the jitters. The first is the number of people who have signed up for new insurance via Obamacare. Just 26,794 chose a plan in October via the dysfunctional federal exchange; even fewer actually bought one. Another 79,391 picked plans on state exchanges. The White House had been hoping for at least 500,000 in the first month.

The second is the number of Americans whose old insurance plans are being cancelled. Mr Obama promised many times that if people liked their health insurance, they could “keep that insurance. Period. End of story.” Now it seems that many of those on the individual market cannot; their plans do not comply with Obamacare’s insurance rules. This irks voters and scares Democrats facing re-election.

More than 90% of the insurance market is unaffected. Mr Obama argues that the old plans were skimpy and that individuals can buy new coverage, often with a subsidy, on the health exchanges. That is scant consolation when the exchanges hardly work. On October 1st 54% of Americans thought Mr Obama honest, compared with 41% who did not. Those numbers flipped in a survey published by Quinnipiac University on November 12th: 44% found him to be trustworthy, compared with 52% who did not.

Health officials are scrambling to make Obamacare work. Ideally, contractors would repair healthcare.gov, the federal exchange for shoppers in 36 states. Kathleen Sebelius, the health secretary, insists that the website will work for the “vast majority” of consumers by November 30th. Perhaps. But that leaves just two weeks for shoppers to buy coverage if they want to be insured from January. And the deadline may be missed: the site continues to send insurers garbled information. As contractors smooth some glitches, others appear.

As an alternative, some may work round the federal website. Mrs Sebelius is urging people to sign up for coverage by phone, in person and by post. HealthMarkets, a firm with hundreds of insurance brokers, has seen a surge in business, particularly in states that depend on the federal exchange. But the federal website is still the only way to determine whether someone qualifies for tax credits. In May the Congressional Budget Office predicted that subsidised shoppers would be 85% of those enrolled in the exchanges next year.

Even trickier is the question of how to help those with cancelled plans. Mr Obama apologised to those whose plans were cancelled on November 7th on NBC, saying: “I am sorry that they are finding themselves in this situation based on assurances they got from me.” It is no longer just Republicans who are getting shirty. Plenty of Democrats now favour a bill that would let individuals keep their current plans. Other Democrats want to delay the mandate that individuals buy insurance.

But these changes would create their own problems. For example, there might not be time for insurers to reinstate cancelled plans by January. Delaying the mandate could mean fewer healthy people buy insurance; only the sick might sign up. David Cordani, the boss of Cigna, a big insurer, warns against isolated, politically-driven changes. “Pulling out one component of a highly integrated law is very dangerous,” he says.