As we continue our open enrollment campaign, we experienced a welcome surge in enrollment as millions of Americans seek access to affordable health care coverage through new Health Insurance Marketplaces nationwide. More than 1.1 million people enrolled in a qualified health plan via the Federally-facilitated Marketplace from October 1 to December 24, with more than 975,000 of those enrolling this month alone. Our HealthCare.gov enrollment nearly doubled in the days before the January 1 coverage deadline compared to the first few weeks of the month. December enrollment so far is over 7 times that of October and November. In part, this was because we met our marks on improving HealthCare.gov: the site supported 83,000 concurrent users on December 23rd alone.
While administration officials had said for months they would only release enrollment figures on a monthly basis once they launched HealthCare.gov, this marks the second time in a week and-a-half they have disclosed such details. On Dec. 20 President Obama announced in a news conference “more than 1 million Americans have selected new health insurance plans” on the state and federal level, with more than half of that coming from enrollments through HealthCare.gov…
At this point nearly 2 million Americans have signed up under the new health-care law so far on both state and federal marketplaces. Roughly 850,000 people have enrolled on the state level, according to Charles Gaba, a Web designer tracking health law enrollment numbers.
Whether this is good news depends a bit on the context you put it in. Obviously enrollment has spike dramatically in December. Just as the administration has predicted — and hoped — there was a rush to sign-up in December, right before the deadline to get coverage starting Jan. 1. Lots of these people weren’t first-time shoppers; many had started shopping in October and had been stymied by technical issues. Their December signup wasn’t a product of procrastination: It tended to have a lot more to do with the fact the website wouldn’t let them sign up earlier.
The administration had previously projected 3.3 million signups through the end of December, so 2 million obviously falls quite short of that. So while enrollment is increasing rapidly, the White House is still behind where it had expected to be at this point.
Most health policy experts would expect enrollment to level off, or even fall, in January and February, when shoppers aren’t facing an imminent deadline. But they do foresee a big increase at the end of March, right before open enrollment closes. These next three months will be pretty important for seeing whether the law hits the Congressional Budget Office projection of 7 million enrollees in 2014 — or, as it has in the first three months of enrollment, continues to fall short.
Scott Gottlieb, a critic of the Affordable Care Act and a fellow with the American Enterprise Institute, a libertarian Washington think tank, said the numbers announced by the administration were “well behind” expectations.
“They only announced 1.1 million. They were at 900,000 December 22nd,” Mr. Gottlieb said on “Fox News Sunday.” “We haven’t seen the rush we thought we would see at the end of the year.”…
Mr. Gottlieb said the numbers might not pick up in the first months of 2014 either.
“The uninsured are not entering the exchanges because the plans are still expensive for them,” he said.
[T]he announcement, which came in the form of a blog post from CMS administrator Marilyn Tavenner, left many key questions unanswered.
To start, the figure doesn’t reveal how many people actually paid for health plans as of Dec. 24. Though payment is what typically makes enrollment official, up to this point, CMS has counted people as being “enrolled” if they merely went through the process of picking a health care plan.
Additionally, CMS still hasn’t provided a demographic breakdown of those who have signed up for insurance through the exchange, which is a key metric for measuring the success of Obamacare, because the exchanges need a critical mass of young and healthy individuals to offset the cost of covering older and sicker enrollees and those with pre-existing conditions.
Tavenner said fixes to the website, which underwent a major overhaul to address widespread outages and glitches, contributed to December’s figures. But the problems haven’t totally disappeared. Thousands of people wound up waiting on hold for telephone help on Christmas Eve for a multitude of reasons, including technical difficulties…
But insurers have complained that another set of technical problems, largely hidden from consumers, has resulted in the government passing along inaccurate data on enrollees. The White House says the error rate has been significantly reduced. Yet with a flood of signups that must be processed in just days, it remains unclear whether last-minute enrollees will encounter a seamless experience if they try to use their new benefits come Jan. 1.
The political fallout from the website’s calamitous rollout could pale in comparison to the heat that Obama might take if Americans who signed up and paid their premiums arrive at the pharmacy or the emergency room and find there’s no record of their coverage.
If Democrats get their way, the next phase of the Obamacare wars will see something unusual: a flood of success stories.
The White House, Democratic lawmakers and advocacy organizations will launch a campaign this week to highlight real-life experiences under the Affordable Care Act — tales so compelling that they help drive up enrollment, marginalize Republican repeal efforts and erase memories of this fall’s HealthCare.gov debacle…
But the West Wing is still on edge. Aides who failed to detect the warning signs on HealthCare.gov are reluctant to say that they’ve got this next phase completely under control, aware that there could be issues they didn’t foresee.
Like thousands of other Americans, Munstock ran into technical problems with the federal Web site before managing to pick a health plan Dec. 1. He qualified for a federal subsidy to help him afford the insurance, so he has to pay just $87.57 a month toward his premium. After his welcome packet from Blue Cross Blue Shield of Tennessee arrived in the mail, Munstock was so eager to finish the process of enrolling and getting an insurance card that he picked up the phone to pay the first premium instead of using the mail.
“It felt really good,” he said. Paying toward his own insurance, he said, gives him “a certain dignity,” a feeling that he is not “one of the takers.” The next day, he called the doctor’s office. His appointment for a physical is Jan. 2.
“I’m feeling surprisingly moved by all of this,” Munstock said. “This finally seems real. And I’m thinking that maybe all the talk and the promises and the messy politics can actually lead to something good after all.”
Even with a boost in enrollment figures, serious trouble threatens the Obamacare horizon. There is the real prospect that when open enrollment comes around next summer, employers will start canceling employee health insurance — preferring to pay the penalty rather than cover the cost of plans with Obamacare-required standards. And the greatest danger to Obamacare itself is the imbalance in enrollees. An older, sicker population is signing up. Younger, healthier customers — who make the economics viable — have stayed away, turned off by website problems as well as concerns about the security of their personal information. Will the White House be forced into a taxpayer-subsidy of insurance companies to keep the whole thing afloat? Will premium costs rise to keep the whole thing afloat? Talk about political dynamite…
To truly appreciate the uneasiness among Senate Democrats, it pays to listen to West Virginia Senator Joe Manchin, among the most outspoken Democrats calling for a delay in the health care law. Manchin worried out loud on CNN’s State of the Union last Sunday that the whole health care law could be headed for a “complete meltdown” if “it’s so much more expensive than what we anticipated, and if the coverage is not as good as what we’ve had.”
The enrollment figures may be well short of what the Obama administration had hoped for. But the fact that a significant number of Americans are now benefiting from the program is resulting in a subtle shift among Republicans.
“It’s no longer just a piece of paper that you can repeal and it goes away,” said Senator Ron Johnson, Republican of Wisconsin and a Tea Party favorite. “There’s something there. We have to recognize that reality. We have to deal with the people that are currently covered under Obamacare.”
And that underscores a central fact of American politics since Franklin D. Roosevelt signed the Social Security Act during the Depression: Once a benefit has been bestowed, it is nearly impossible to take it away.
Until Congress repeals ObamaCare, this is what health care will look like in America. Republicans will complain when Democrats jerk your health plan hence. Democrats will complain when Republicans jerk your health plan hither. Presidents from both parties will push the executive’s discretionary powers up to and beyond their lawful limits. Democratic and Republican presidents will “strongly encourage” insurers and health care providers to do things that no law requires, such as pay the medical bills of patients who have not paid a single premium, and the beholden insurers and providers will comply “voluntarily.” Republican and Democratic presidents will withhold information about their own performance, so there is no way to verify its own stellar self-assessments. Still, ObamaCare is definitely not a government takeover.
[O]ne of two things will happen in 2014. The first is that access to doctors will fall and the cost of care will go up for most Americans; Democrats will (gradually) realize they’ve been misled, and support for the law will collapse.
The second possibility is that access to doctors and the cost of care won’t change for most Americans; Republicans will (gradually) realize they’ve been misled, and the case against Obamacare will disintegrate for the average voter. Fear of that outcome may explain why Republican leaders have been so frantic in trying to undermine the law now — they’re afraid that once their base realizes the warnings about Obamacare were wrong, they will stop paying attention.
It seems almost unnecessary to note, a week before the law’s coverage provisions take effect, that the vast majority of Americans who get their insurance outside the exchanges won’t see any big difference in cost or in their ability to see their own doctor. Unnecessary, because whether you agree with me or not, we’re about to find out. All we know for sure is that somebody is wrong.