The new year places the Affordable Care Act once again in the cross hairs of the national debate; 2014 is an election year, meaning the political battered Obama administration will have to ramp up its campaign to accentuate the benefits brought to Americans by the healthcare reform. Since the Affordable Care is “no longer just a piece of paper that you can repeal,” the election year also means a change in party politics is an absolute must for the Republican party. By the end of March, as many as 8 million to 10 million people may have insurance coverage thanks to Obamacare.
More importantly, for the reform’s political future, is not how the administration defends the law’s benefits and its political opposition highlight the law’s flaws, but how Americans who purchase insurance policies via the online exchanges judge the affordability and quality of their coverage. That judgement will either confirm or undermine the viability of the healthcare reform. When January 1 dawns and the policies that have been purchased through the cornerstone provision of the Affordable Care Act become active, the real test will begin.
As the Obama administration announced Monday morning, more than 975,000 people signed up this month for health insurance under Obamacare, pushing the total number of people who have enrolled in a “qualified health plan” through the 36 federally-facilitated marketplaces since their October 1 launch to more than 1.1 million. In addition, calculations conducted by Brainwrap’s Charles Gaba, show that the most recently available numbers published by state-based exchanges put enrollments made through the marketplaces created by those states and the District of Columbia totaled around 2 million. Plus, nearly 4 million people will be newly covered thanks to the law’s expansion of Medicaid.
“We are in the middle of a sustained, six-month open enrollment period that we expect to see enrollment ramp up over time, much like other historic implementation efforts we’ve seen in Massachusetts and Medicare Part D,” said Marilyn Tavenner, administrator of the Centers for Medicare & Medicaid Services — the governmental division responsible for overseeing the operation of the federal healthcare website, Healthcare.gov — in a December 30 statement.
Since the Affordable Care Act was signed into law in March 2010, the Obama administration has used the implementation of a similar healthcare reform in Massachusetts as the gauge for the nation-wide roll out. As in Massachusetts, enrollments via the Affordable Care Act-created insurance exchanges was long expected to begin slowly and then later gain momentum. While current numbers may be slightly below early estimates, enrollments are not far off from the government’s prediction that around 3.3 million people will have purchased policies by January. Based on calculations made by the nonpartisan Congressional Budget Office, the Obama administration also expects that around 7 million people will have signed up by the end of the six-month enrollment period on March 31, 2014.
The problem is that while CMS has cited 1.1 million as the total number of sign ups through December 24, individuals who have “selected a marketplace plan,” to use official speak, are only considered to be enrolled once insurers have received payment of the first month’s premium. In early December’s ProPublica’s Charles Ornstein, quoting insurance industry consultants, reported that between 5 and 15 percent of individuals who had selected a marketplace plan had made that payment. Even more worrisome is the fact that CMS Deputy Chief Information Officer Henry Chao said during a November congressional hearing that the system to pay insurers had not yet been built.
Another question for those interested in analyzing the government’s official sign up numbers is how many so-called healthy individuals have signed up for coverage compared to older and sicker individuals, who will most benefit from the exchanges. But that number has not been released. Healthier Americans are cheaper to insure, needed to keep insurers’ risk pools balanced, and less likely to purchase Obamacare insurance policies.
Even though it must be remembered that around 17 million people — or about 60 percent of the 29 million people who could make up the market for the health insurance exchanges — will be eligible for subsidized insurance, the Monday announcement from CMS shows that the growing numbers of Americans are interested in purchasing Obamacare insurance. The fact that the federal healthcare website was able to handle 83,000 concurrent users on December 23, which was likely one of the busiest days for healthcare.gov since the exchanges launched, shows that the design flaws and software errors that impeded enrollments early on are fading away.
But without more detailed information regarding the age and health of people that have selected a marketplace plan, it is difficult to analyze whether exchange system will ever function as they were intended. Plus, public support for the reform continues to ebb; according to the Kaiser Health Tracking Poll from December 2013, just 34 percent of the public holds a favorable view of the Affordable Care Act.
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