The number 6 says it all about the HealthCare.gov rollout

When it comes to health care, the rollout of the Affordable Care Act was supposed to be measured in the millions. That's how many people were expected to sign up for insurance to begin on Jan. 1.

But for both supporters and opponents of the law, there's one number that sticks out above all others. Six. That's how many people actually managed to enroll through the federal HealthCare.gov website the first day it opened, Oct. 1. About the only thing that was clear for the first month was that, except in a handful of states, things were going anything but smoothly. Federal officials steadfastly refused to release any enrollment numbers until mid-November. That led to cries of outrage from political pundits, threats of investigations by members of Congress, and a steady stream of ridicule. On Oct. 27, Saturday Night Live opened its show with Kate McKinnon playing embattled Health and Human Services Secretary Kathleen Sebelius.

"If our website still isn't loading properly," McKinnon deadpanned, "we're probably just overloaded with traffic. Millions of Americans are visiting HealthCare.gov. Which is great news. Unfortunately the site was only designed to handle six users at a time."

Little did SNL's writers know how accurate they were. Just days later, notes subpoenaed by the House Oversight Committee revealed that was precisely how many people successfully navigated the site from beginning to end on HealthCare.gov's opening day. "You could not have had a more difficult start for the law," Drew Altman, president and CEO of the Kaiser Family Foundation, said in an interview.

Altman says the botched rollout had two main impacts. One was on the millions of people actually trying to sign up, "because it may have turned off people who wanted to enroll. And we will see how many of those people come back and keep trying."

But even more important is the political impact of adding more fuel to an already raging partisan fire.

"It was another blow for the law," Altman says, "and so you saw that in the polls, and our poll — support for the law went down, and it is at a lower level now." Douglas Holtz-Eakin, president of the American Action Forum, a center-right think tank, says the damage done by the botched rollout was significant. "This is one of the lessons in politics," he said in an interview. "If they're laughing at you on the late-night shows, or if Jon Stewart is making fun of you on The Daily Show, then you're in trouble. And they are in trouble."

Indeed, liberal late-night darling Jon Stewart lit out after the website mess on a regular basis during the early weeks.

"HealthCare.gov is one month old," he said on the show Oct. 31. "And like most 1-month-olds, it is still just laying there pooping its pants ... and angering anyone that it is not related to." On Oct. 7, Stewart conducted one of the first interviews with HHS Secretary Sebelius since the website launch, in which he pulled no punches. It was widely considered a debacle by the administration.

But he also went on to chide Republicans for exaggerating the law's shortcomings and suggesting that going back to the health care system pre-Affordable Care Act would somehow be better.

"I guess back then you were OK," he said on Nov. 6, "because if you liked not having a doctor, you got to keep not having a doctor. Period."

In other words, the Affordable Care Act had taken over the national conversation in a way it had not since its passage in 2010.

Even with things working better now, the rocky rollout will be difficult for the law to overcome, says Holtz-Eakin.

"We see in the polling the negatives are stronger; we see among the uninsured, those who would presumably benefit from the program, a confusion and a dislike of the program," he says. "It's very difficult to change the image that this is not a good thing and you want to steer clear of it."

But Altman says the success or failure of the law in the end won't be measured by how well the website works, but by how people react to the insurance they're now purchasing.

"We will see over the next year, as people begin to use services, whether they like the deal they got — whether they think the coverage they got is affordable or not," he said.

In fact, the number six is already becoming something of a distant memory. At his news conference Dec. 20, President Obama announced that more than a half-million people signed up through HealthCare.gov in the first three weeks of December. And many major social programs, including the most recent — Medicare's prescription drug benefit — got off to rocky starts. Most are now firmly embedded in the social and political fabric of the nation. Copyright 2019 NPR. To see more, visit https://www.npr.org.