Documents obtained by Republican Representative Darrell Issa of California show that in the first day after the online marketplaces, the cornerstone provision of the Affordable Care Act, went live, just six people nationwide had actually enrolled for insurance plans. By the second day, that number had only risen to 248. Those figures were included in notes from twice-a-day “war room” meetings convened at the Centers for Medicare and Medicaid Services after the federal website’s glitch-plagued October 1 launch, notes that were released Thursday night to the House of Representative’s Oversight and Government Reform Committee, which Issa chairs. Sitting in on the meetings were both administration officials and government contractors.
“High capacity on the website, direct enrollment not working,” the October 2 notes read. By later that day, “approximately 100″ enrollments had taken place. The first 31 days of the six-month open enrollment period for the individual markets were plagued by software errors that caused hours-long wait times, prevented potential customers from creating accounts and completing the 30-step enrollment process, sent insurers the wrong information, and made it difficult for customers to get an accurate cost estimate.
Exchange glitches have been a particular rallying point for those that oppose the Affordable Care Act, spawning a series of congressional hearings. They have also put the success of President Barack Obama’s signature first-term legislative achievement on tenuous ground. If enrollments remain low, the health care reform will have dismally delivered on one of its main promises, expanding affordable coverage to many of the country’s 48 million uninsured.
On the one hand, the revelation is not surprising. “We expect the initial number to be small,” said Centers for Medicare and Medicaid Services Administrator Marilyn Tavenner during her Tuesday testimony before the House Ways and Means Committee. Her department was responsible for insuring the federally-facilitated exchanges would be operational by the October 1 deadline. Since the Affordable Care Act was signed into law in March 2010, the Obama administration has used the implementation of a similar health care reform in Massachusetts as a bar for the nation-wide rollout. It was the Massachusetts case that Tavenner referenced during her testimony to explain why initial enrollment numbers could be lower than originally expected.
The Obama administration has calculated that approximately seven million people will enroll for coverage via the exchanges by March 31, 2014 — the last day of the enrollment period. But, similar to the Massachusetts rollout, the first month may be below the expected monthly average. “The Massachusetts experience was very slow initially and then it started to ramp up over time,” said Tavenner. “We expect the same type of projections.”
“Our projections prior to launch were always that there would be a very small number at the beginning,” Department of Health and Human Services Secretary Kathleen Sebelius said, who testified before the House Energy and Commerce Committee Wednesday. “We watched the Massachusetts trend, which started slowly and then built. I think there is no question that given our flawed launch of healthcare.gov it will be a very small number.” On average, the health care exchanges need 39,000 enrollees per day to meet the goal of seven million by March 1.
However, while Tavennar said the administration expected enrollment numbers to be low, both she and Sebelius have repeated over and over again that the official enrollment numbers would not be available until mid-November because officials “do not have any reliable data around enrollment,” as Sebelius told lawmakers Wednesday. But nevertheless, for the past 31 days, the administration reiterated its main talking point time and time again: millions of Americans are visiting the federal health care website despite the technical problems.
A spokeswoman for the Department of Health and Human Services, Joanne Peters, told Bloomberg Thursday night that the notes do not reflect “official enrollment statistics.” As of October 25, 700,000 people had submitted applications for insurance via the Obamacare insurance exchanges, she said, with approximately half of those enrollments coming from states that deferred to federally-facilitated exchanges. For the most part, the fourteen states that chose to build and run their own exchanges have suffered far fewer glitches, but Peters’ comments indicated that the enrollment numbers are similar.
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