The next wave of enrolments to President Barack Obama’s signature healthcare scheme, so despised by Republicans, began this month, but his administration is still struggling to iron out the kinks in the system.
For a president whose sophisticated election machine helped sweep him to power on a mastery of modern-day number-crunching, it is a surprise Obamacare, as the Affordable Care Act is better known, has been so plagued by computer glitches since it began in October 2013. Those glitches haven't gone away.
The 2010 passage of the most radical piece of social legislation in decades was a triumph for Obama and will, possibly alongside his sweeping executive orders announced on Thursday night helping five million illegal immigrants, be the landmark of his presidential legacy.
Any measures that help the 57 million people who were without healthcare cover to afford a recovery is a positive step. The system does little to address deeper, underlying the problems in the American health system, however: the extortionate cost of medical expenses and drugs.
This year my wife was charged $200 (€160) for a five-day course of antibiotic eye drops to treat an infection.
Obamacare, the bete noire of Republicans in the 2010 and 2012 elections, was less of an issue in this month’s midterm election cycle, as many of the almost seven million who signed up for the insurance scheme appeared to see the benefits of lower premiums.
This hasn’t stopped Republican opposition. The party’s members in the House of Representatives have just filed a long-threatened lawsuit claiming the law abuses Obama’s executive authority.
My own experience of Obamacare has been something of a nightmare, having lost insurance cover for myself and my family for a month this year and my original GP in the changeover.
The chaos of the move to the new system seems to have been exacerbated by the inability of American bureaucrats to cope with the most basic administrative tasks. To pick at the sore even more, premiums are set to rise in the second year of enrolment.
This week Obama's secretary of health and human services Sylvia Mathews acknowledged the administration had got its numbers wrong on enrolments so far. A figure of 7.3 million sign-ups for health insurance plans reported in September should have been 6.97 million, congressional investigators discovered.
Mathews apologised, describing the errors as a “mistake” that were “unacceptable”. Double-counting was blamed, as people who signed up for both dental insurance and health insurance were tallied separately.
The administration has managed down expectations on the number of expected enrolments next year, to between nine and 9.9 million, far below below the 13 million people the government’s independent research authority estimated would enrol by the end of 2015.
The department of health and human services has said it will be after 2017, perhaps well beyond then, before the 25 million enrolments that the budget office had predicted will be reached.
One group being targeted in the second wave of Obama enrolments are Native Americans. Although they are exempt from the requirement under the law fining them for not having health coverage, Native Americans can sign up for private insurance through the Obamacare federal or state healthcare exchanges.
Just 0.4 per cent of enrollees to date were American Indians, Alaska Natives, Native Hawaiians or residents of US-controlled Pacific Islands.
Two million Native Americans in 566 tribes have their own hospitals and clinics through the Indian Health Service, set up under government treaty promises to provide healthcare to tribes in exchange for giving up their lands.
Their health service is struggling to cope. Senator Jon Tester of Montana, a state where Native Americans are being targeted for Obamacare, told radio station NPR that the Indian service basically runs out of money about nine months into the fiscal year.
Lesa Evers, a member of the Turtle Mountain tribe and an employee of Montana's state health department, told the station the service's budget crisis means that tribal members could only receive healthcare if they were in immediate danger of losing life or limb.
Thursday is the 393rd anniversary of the Thanksgiving feast between the Pilgrims and Wampanoag Indians, a holiday that some American Indians choose instead to mark as a day of mourning.
American Indians still face risks to their health due to inadequate federal support. Selling Obamacare deep into their heartlands will require a much more effective rollout of the new healthcare system.