Forty-eight percent of Americans polled by Kaiser Health Foundation in the middle of October said they believe the Obama administration has done a “poor” job of implementing the Affordable Care Act. Yet a nearly equal share, 47 percent, believe that the health care reform law, known popularly as Obamacare, should be kept or expanded, while only 37 percent said it should be repealed. Among lawmakers, opinion is mostly divided along partisan lines, and as President Barack Obama and his administration continue to defend the underlying value of the health care reform despite the technical problems that have kept enrollment numbers low and given ammunition to the law’s opponents, the opposition has ramped up. “I think government is inherently inept, because they don’t work on a profit motive,” Kentucky Republican Rand Paul said on ABC’s “This Week.”
For former governor of Massachusetts and 2012 Republican presidential nominee Mitt Romney — who implemented a health care reform of his own with a similar individual mandate — the sticking point was the fact that the president misled the public by repeatedly promising: “If you like your doctor, you can keep your doctor. If you like your current health insurance plan you can keep it. Period.” As Romney said Sunday on NBC’s “Meet the Press,” Obama was not “telling the truth,” and that “fundamental dishonesty has really — has really put in peril the whole foundation of his second term,” he added. “I think it is rotting it away.” The president’s pledge undermined the president’s credibility, Romney said. So far this fall, around 2 million Americans have received policy cancellations from their insurers, proof to the Obamacare opposition that Obama lied when making that oft-repeated pledge.
Despite Romney’s strong opposition to the Affordable Care Act during his campaign, Romneycare — signed into law in 2006 — was an important model for the nationwide reform. But the state program did not suffer the same technical problems as Obamacare’s federal online insurance marketplace.
For the Obama administration, technical problems mean enrollment problems. Initial numbers will be low, but even the Department of Health and Human Services, or the HHS, is not sure how many people have enrolled. 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. And it was the Massachusetts case that Centers for Medicare and Medicaid Services Administrator Marilyn Tavenner referenced during her testimony to explain why initial enrollment numbers could be lower than originally expected.
The Obama administration has calculated that approximately 7 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 health care exchanges need approximately 39,000 enrollees per day to meet the goal of seven million by March 1.
“We expect the initial number to be small,” Tavenner said during her testimony last week before the House of Representative’s Ways and Means Committee “And I think you’ve seen that in our projection, and that was the Massachusetts experience as well.”
Later in the hearing, the administrator expanded on that explanation. “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.”
A study conducted by the New England Journal of Medicine, which has been cited often by the administration, found that 123 premium paying enrollees signed up in Massachusetts during the first month, while 10,000 signed up for Medicaid plans or plans with no premiums.
Similarly, HHS Secretary Kathleen Sebelius admitted in her testimony before the House Energy and Commerce Committee last Wednesday that the error-riddled federal website, healthcare.gov, would likely mean low sign ups for the first six weeks of the enrollment period. “Our projections prior to launch were always that there would be a very small number at the beginning,” the HHS secretary said. “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.”
Of course, both Tavenner and Sebelius refused to give even the smallest indication of what current enrollment numbers look like; both repeated time and time again that the data would be released in mid-November.
As White House senior adviser Dan Pfeiffer said on “This Week,” the state program enrolled only 0.03 percent of the population in the first month. “I can promise you that the first enrollment numbers, which were released later this month, are not going to be what we want them to be. There’s no question about that,” Pfeiffer said on ABC’s “This Week” program. “The website hasn’t worked the way we want it to work. But we take responsibility for that, take responsibility for the errors, take responsibility for fixing it.”
On the first day after the federal online marketplaces, the cornerstone provision of the Affordable Care Act, went live, just 6 people nationwide had actually enrolled for insurance plans. By the second day that number had only risen to 248, according to figures included in notes from twice-a-day “war room” meetings convened at the Centers for Medicare and Medicaid Services after the website’s glitch-plagued October 1 launch. The low enrollment numbers are not unexpected, as Ezekiel Emanuel, vice provost at the University of Pennsylvania and an architect of Obamacare, told “Fox News Sunday.” So early in the six-month enrollment period, it is expected that because of “everything we know about the exchanges, that not a lot of people would sign up,” he explained.
But it is also true the between 5 million and 7 million individuals will need to enroll for health insurance coverage via the exchange for the system to work, Emanuel added. Meaning only with enrollments of that magnitude will the exchanges have risk pools broad enough to balance out the proportionally higher medical costs of the sicker and older individuals, who will likely be among the first to sign up, without causing premiums to skyrocket.
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