Quotes of the day

RACHAEL RAY: Listen, I want to take time to talk about Healthcare.gov because today is the deadline right?

VICE PRESIDENT JOE BIDEN: That is right. Today is the deadline. I think everyone is going to be really surprised and pleased how well this has turned out. But I want to say one thing, Rachel. Anybody who is in line now, anybody who is on the web, in person being interviewed and/or on the telephone, they are able to — even if the deadline closes — to stay in line. They can get into the system. It is a little bit like people, when the polls close at 8 and there are people waiting, they get to vote. So I think people are going to be really, really surprised how well this has turned out.


As Americans around the country raced on Monday to sign up for health plans in new insurance marketplaces before a midnight deadline, HealthCare.gov, the online federal insurance exchange, was closed to new customers for two periods starting at dawn.

Federal health officials said that a midday shutdown was caused primarily by the large numbers of customers coming to the federal Web site, while software problems were responsible for the site opening about three hours late in the morning…

At noon, 109,000 people at once were on HealthCare.gov, twice as many as the day before, according to federal health officials.

The pauses in new sign-ups have come as record numbers of people on Monday also flooded a network of call centers for help in getting insurance through the marketplaces created by the Affordable Care Act. By noon on Monday, the centers logged 350,000 callers, roughly triple the volume on the second-highest day, Dec. 23, as the deadline approached for people to choose health plans in time for their coverage to start on New Year’s Day.


According to the White House, officials and celebrity surrogates over the past six weeks have completed more than 300 individual radio interviews across the nation. That includes 20 radio interviews by the president, first lady and vice president. Chief of staff Dennis McDonough and senior advisers Dan Pfeiffer and Phil Schiliro participated in an additional 30 interviews. Cabinet secretaries have also completed some 60 radio interviews nationwide.

Valerie Jarrett alone has also completed 60 radio interviews and appeared on TV and Internet shows to promote the initiative. In an interview with Popsugar posted Friday, Jarrett pitched the law and fielded questions on One Direction and Snooki.

That effort has been magnified by the administration’s use of celebrities to get the word out about the ObamaCare deadline. According to the White House, celebrity “influencers” have posted messages about the law to more than 349,481,000 followers and have seen their messages retweeted more than 40,000 times

“A key part of the administration’s strategy has been to work with celebrities, athletes and other key influencers who were interested in helping us get the message out about the importance of getting health insurance, and had an enormous power to reach consumers outside of the Beltway — especially young people — through their social media platforms,” the White House official said.


A better way to measure progress is to look at numbers from a handful of states that are collecting this kind of data and have reported it. Last week, New York officials told CNBC that 59 percent of people getting insurance through the state marketplace had no coverage before. The numbers were even higher in Kentucky, where officials told the network that 75 percent of people selecting plans had been uninsured before.

And according to Seattle Times columnist Danny Westneat, officials in Washington state who have studied their enrollment data believe that the overall effect of Obamacare has been to reduce the ranks of the uninsured by about 25 percent. To give you a sense of scale, the Congressional Budget Office has predicted that the Affordable Care Act will in 2014 decrease the number of uninsured nationally from about 57 million to about 44 million—a reduction of about 23 percent. So if those Washington officials are right, their state is actually outperforming expectations by a little bit…

According to Noam Levey of the Los Angeles Times, unpublished research from the Rand Corporation suggests that the uninsurance rate among working-age adults has fallen from 20.9 percent in the fall to 16.6 percent now. That’s roughly consistent with previously published survey findings from Gallup. Again, it’s hard to know how accurate these surveys are. But they certainly suggest the law is succeeding in reducing the number of people without health coverage. The question is by how much.


According to the Times, which cites a study from Rand Corp., “At least 6 million people have signed up for health coverage on the new marketplaces, about one-third of whom were previously uninsured.” That suggests that two million uninsured Americans gained coverage as a result of the law…

[A]s recently as February — when analysts knew how many states weren’t going along with the Medicaid expansion and were aware of the early technical glitches facing the rollout of Obamacare — the CBO still projected that the law would reduce the number of uninsured by 13 million.

Even adding the 3 million young adults under 26 who were added to their parents’ insurance policies, the resulting 9.5 million total would still be significantly below expectations.


Assume all the numbers are correct, or at least close to correct. By far the largest part of Obamacare’s health coverage expansion has come from a) expanding Medicaid, and b) allowing young people to stay on their parents’ coverage. The part where Democrats essentially blew up the health care markets, imposed the individual mandate, and caused premiums to rise and deductibles to skyrocket? That hasn’t been such a success. If the Times number are correct, all of that — placing new burdens of higher costs and narrower choices on millions of Americans, in addition to setting the stage for coming changes in employer-based coverage — has resulted in two million of the previously uninsured gaining coverage.

The bottom line is that Democrats could have enacted two relatively small changes (small relative to the entirety of Obamacare, that is) in the health care system and achieved most of what Obamacare has achieved so far. Would Republicans have supported such changes back in 2009 and 2010? Who knows? Maybe a few would have — certainly the until-26 change — but the point is in the brief period when Obamacare was enacted, Democrats had about 255 votes in the House and 60 in the Senate. They could do what they wanted, which included pursuing more modest reforms that would have helped millions. Or they could blow things up and impose burdens on millions even as they helped others. Acting on decades of pent-up demand to take control of the health care system, they chose to blow things up.


What’s important to remember is that this is not how Obamacare was supposed to work. The Congressional Budget Office, in its original estimates, predicted that the vast majority of the people eligible for subsidies on the exchanges would be previously uninsured individuals.

Instead, the vast majority are previously insured people, many of whom are getting a better deal on the exchanges because they either qualify for subsidies, or because they’re older individuals who benefit from the law’s steep rate hikes on the young…

This is a problem that may get worse over time, as the cost of plans continues to go up. In the McKinsey survey, of those who had decided not to sign up for Obamacare, the most common reason was the “affordability” of the offered plans. Indications from insurers like Aetna and WellPoint is that the premiums on the exchange will go up substantially next year.


The CEO of the Cleveland Clinic says that a majority of Americans who signed up for Obamacare have seen their premiums rise.

“About three-quarters of them find that their premiums are higher than they had been previously with other insurance,” Toby Cosgrove told Fox News…

“We know for example that we’re going to get paid less for what we do,” Cosgrove stated. “Hospitals are going to be paid less for what they do. We also know that insurers are paying less for what we do.”


I was one of those people who made a “firm pronouncement about how the Affordable Care Act (was) doing.” I fully expected the numbers of uninsured to skyrocket this year.

But that was because I thought the law was the law. I expected that the massive cancellations of group plans throughout 2014 would result in 25 million people previously covered to be wandering in the wilderness this year trying to figure out what to do next.

I had no idea that the law could be changed or delayed with a wave of the imperial hand. Silly me. Today, I have completely lost track of what is still required and what has been delayed. So I have sworn off making “firm pronouncements” of anything having to do with this bucket of porridge known as Obamacare… and I suggest others should, too.


“Even though the website is working, the stench of the rollout lingers. Sebelius’s screw up will almost certainly cost us a bunch of seats,” said one Democratic operative. “But in time — certainly going into 2016 — the politics of the ACA will change. People do not like to lose benefits once they have become accustomed to receiving them. Why do you think the Dems never fundamentally changed or repealed the Bush prescription drug entitlement?”

That’s why Democratic campaign officials want to put so much focus on what would happen if the nation went back to the old health care system. Until now, they’ve spent more time trying to find success stories of newly insured, happy people. But for the elections, they’re leaning toward a different approach: finding horror stories of people who used to get turned down for health insurance or bankrupted by an illness, and having them say in TV ads, “Don’t make me go back to that.”

Democratic pollster Mark Mellman points out that the newly insured people haven’t had a chance to show whether they will be committed voters yet. “If you can communicate with them and explain what they stand to lose if the law is repealed, that will make a difference,” he said Mellman. “By November, we’ll be in a different position with those folks.”


As the Obama administration and the uninsured race to meet today’s (sort-of) deadline for Americans to have purchased health insurance, we can now say something we weren’t 100% confident about back in October in November: The health-care law is here is to stay. More than 6 million have now enrolled in a health-care plan under the federal and state exchanges, which is up from a mere 100,000 back in October. And given the recent enrollment surge, it’s possible the final number is close to 7 million. What’s more, when you add the folks who’ve gotten insurance via expanded Medicaid and those under 26 who are on their parents’ insurance, overall total could be as high as 15 million. (So even if you subtract the 5 million Republicans estimate had been insured before, the net new insured appears could be around 10 million.) And then consider that the Congressional Budget Office has projected enrollment in the exchanges to double in 2015 (from 6 million to 13 million) and nearly double again in 2016 (from 13 million to 22 million). Bottom line: Repeal is more unlikely than it’s ever been before. How do you negate the health-care plans for these millions of Americans? So now what?…

”Next year is going to be interesting. What we’re hearing from the insurers thus far is that they’re expecting double-digit increases for the cost of these health plans on the exchange in 2015,” conservative health-care expert Avik Roy said on “Meet the Press” yesterday. “We still haven’t heard about how much the plans are going to cost for employer-sponsored insurance under Obamacare as it was before. And those things are going to affect the election in November for sure.” Liberal health-care expert Jonathan Cohn countered, “We’ll wait and see where those premiums come in. They are getting a lot of people in now,” he said on “Meet the Press” yesterday. “You know, there’s been this pattern where they always predict the worst. You know, the website wasn’t working: ‘No one will ever sign up.’ And then it was, ‘Well, no one will get to the doctor.’ And you know what? Things were okay. There were problems, but things worked out well. I’m pretty optimistic.”


We don’t know yet what the paid enrollment looks like or how successfully the program is actually enrolling the uninsured. (After some grim estimates, this Rand study is making liberals feel a little more optimistic, but still suggests a below-expectations result.) We don’t know what the age-and-health-status composition of the enrollee pools looks like or what that means for premiums next year and beyond. We don’t know if any of the suspended/postponed provisions of the law will actually take effect. And we certainly don’t know what any of this means for social policy in the long run.

But we do know that there won’t be an immediate political unraveling, and that we aren’t headed for the kind of extremely-low-enrollment scenario that seemed conceivable just a few months ago, or the possible world where cancellations had ended up outstripping enrollment, creating a net decline in the number of insured. And knowing that much has significant implications for our politics. It means that the kind of welfare-state embedding described above is taking place on a significant scale, that a large constituency will be served by Obamacare (through Medicaid as well as the exchanges) in 2016 and beyond, and that any kind of conservative alternative will have to confront the reality that the kind of tinkering-around-the-edges alternatives to Obamacare that many Republicans have supported to date would end up stripping coverage from millions of newly-insured Americans. That newly-insured constituency may not be as large as the bill’s architects originally hoped, or be composed of the range of buyers that the program ultimately needs. But it will be a fact on the ground to an extent that was by no means certain last December. And that fact will shape, and constrain, the options of the law’s opponents even in the event that Republicans manage to reclaim the White House two years hence.



Via RCP.