Obamacare has rolled out and by all accounts it has been one of the worst initial rollouts of a major public policy ever.  The much heralded federal website, healthcare.gov, the site that was supposed to make shopping for Health insurance as easy as shopping for a book on Amazon, crashed the very first day.  Millions of people who were looking forward to shopping for their insurance encountered nothing but error messages, long wait times and frozen screens.  It has gotten only marginally better in the time since.

But if you are an opponent of the Health Care law and are banking on the website’s malfunctions to bring the law down, you may be setting yourself up for disappointment.  You see, the website will eventually be fixed.  This administration will spare no expense in addressing the problems and they will eventually iron out whatever bugs are causing this mess.  In other words, the website will not be a long term problem.

But there are structural problems that have the potential to eclipse the website’s woes as the Number one impediment to Obamacare’s functionality.  Problems that if left to play out, and if not curbed, either by the law’s existing statutes or by new ones, will present serious challenges to the long term health of Obamacare. 

The President has said, for example, that if Americans like their existing health care plans, they can keep them.  That was a major selling point for the law back in 2010.  It’s turning out not to be true.  It’s estimated that about 5% of all insured person in the US are at risk of losing their Health Insurance because of Obamacare’s new requirements.  That’s about 15 million people.  Not a small number.  Now there are estimates that the true number may be even higher.

Another issue is the expansion of Medicaid.  Medicaid was expanded under Obamacare, set up originally as an incentive for states to create their own health care exchanges.  Depending on income level, health care may be entirely free of charge for some.  That has the potential of dramatically expanding the nation’s dependency roles.  We’re already seeing some evidence of that.

So far, the vast majority of enrollees in Obamacare are to Medicaid.  In some states it’s as much as 90%.  The financial assumptions that Obamacare makes is that roughly 7 million people must buy health insurance plans in order for the program to remain viable and for premiums to remain affordable.  If significantly less than that sign up the system may run into trouble and premiums may skyrocket.  Proponents of the law point out that it’s still too early to accept these early numbers as permanent trends, which is true.  But the pace will need to pick up soon if the enrollees in public and private insurance are going to come into balance. 

The administration has set a new deadline of the end of November for the website to be functioning properly.  But it will matter little that the site is fully functional if millions of people are getting kicked off their existing policies against their will.  Or if the number of people enrolling in free health care through Medicaid outnumbers the number of people purchasing private health insurance by so much that the program is no longer sustainable.  There are early trouble signs with the law that may potentially turn into real long term problems.  And these extend far beyond simple technical glitches on a website.