Obamacare Deadline Day Sees 4-Hour Healthcare.gov Blackout

Source: Thinkstock

Source: Thinkstock

Monday is the final day of the six-month enrollment period for the Affordable Care Act-created insurance marketplaces and, as the Centers for Medicare & Medicaid Services announced Thursday, more than 6 million Americans have signed up for coverage through the exchanges, meaning the Obama administration’s target enrollment figure had been met. Given that March 31 is the end of an important moment in the history of the healthcare reform, the conclusion of the enrollment period provides a moment of reflection for Obamacare’s supporters and its critics, especially since the federal healthcare website has shown some signs of stress ahead of Monday’s midnight deadline.

On Monday, individuals attempting to enroll for private health insurance through the exchanges received messages informing them that the website was “currently unavailable.” The federal healthcare website, Healthcare.gov, which has been plagued by technical problems since October, went down for several hours on the morning of March 31, the Department of Health and Human Services announced. “[The] tech team is working now to bring the system online as soon as possible,” a statement obtained by NBC noted. The four hour blackout was not the result of overwhelming last minute demand, nor the result of hackers, but a technical glitch.

Exchange problems have been a particular rallying point for those that oppose the Affordable Care Act, who deem these issues as evidence of the flaws of the reform. But now, “the ACA has survived an election and a Supreme Court challenge and a government shutdown and a website debacle, and now doubts about its enrollment totals,” as Kaiser Family Foundation President Drew Altman told the National Journal.

The United States is the only rich country in the world to not have universal health coverage; in basic terms, the Affordable Care Act — signed into law on March 23, 2010 — was meant to drastically lower the number of uninsured Americans. More specifically, Obamacare was designed to make affordable health insurance accessible to most all Americans via a two-part system: the expansion of Medicaid and the creation of insurance exchanges where individuals will be able to comparison-shop for health insurance policies in online marketplaces where their collective bargaining power will theoretically foster competition and drive down prices. Subsidies in the form of tax credits were also included to make coverage more affordable for the exchange enrollees that qualify. This expansion essentially sets a national Medicaid income eligibility level of 138 percent of the federal poverty level, or about $27,000 for a family of three for adults. Historically, Medicaid eligibility generally was restricted to low income individuals in a specified category, such as children, their parents, the elderly, or individuals with disabilities.

When the exchange system — comprised of 36 federally-facilitated marketplaces and 15 state-run marketplaces — launched on October 1 of last year, the worry was that enough Americans would not sign up for coverage to make the reform’s cornerstone provision viable. Experts have said between 5 million and 7 million individuals will need to enroll for health insurance coverage via the exchange for the system to work, 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.

Furthermore, if enrollment numbers had been low, the healthcare law would have failed its most basic mission: to increase the number of insured Americans. But, the glitch-riddled rollout of the exchange system put success in jeopardy. In the final months of last year, administration documents obtained by Republican Representative Darrell Issa of California showed that in the first day after the federal online marketplaces went live, just six people nationwide had actually enrolled for insurance plans. By the second day, that number had only risen to 248. Those low figures not only spurred Republican criticism, but put into question whether the enrollments would reach the administration’s targets.

Originally, before the October 1 launch of the marketplace system, the nonpartisan Congressional Budget Office calculated that as many as 7 million people would enroll by March 31. But after the federally-created online insurance marketplaces launched with software errors and design flaws that for weeks caused hours-long wait times, preventing potential customers from creating accounts and completing the 30-step enrollment process, and sending insurers the wrong information, the CBO lowered the estimate to 6 million.

Hitting this milestone of 6 million is important for both the administration and for the success of the overall healthcare reform. It gives the White House strong evidence that the healthcare reform has made significant inroads into making health coverage available to the nearly 50 million uninsured Americans, which will be key the Democrat party’s hopes in the upcoming midterm congressional elections. This milestone is also important in the history of the reform. In the past year, during which the insurance exchanges opened for business, the law moved from a debate based in vague political abstraction to one of concrete successes and failures. While real world data is now available on enrollment numbers and premium prices, key data describing the law’s future viability has yet to be released, including the percentages of enrollees who were previously uninsured and how many people paid their first premium.

Still, it is true that an important hurdle has been cleared; enough Americans have signed up for coverage through the reform’s marketplaces to keep the system afloat. Of course, far more important to the overall success of Obamacare is not the national enrollment numbers but the stability of local numbers as insurance is based on local markets. More specifically, what matters is how many enrollees sign up each area and what percentage of them are health and cheap to insure. ”There definitely is no magic number,” Altman told CNN. “It will vary a lot around the country.”

But with the target of six million enrollments reached, it is time to focus on those successes and failures, as well as what true long-term success will look like. Republican critics claimed that the Affordable Care Act would destroy jobs and the exchange system would collapse under its own weight, which has not happened, while Democrats lawmakers argued that that the American public would embrace the reform, which also has not happened on a widespread level. What has happened will take time to digest, and governments health officials will need to analyze the stability of risk pools, the size of premium increases, and whether consumers like the coverage the Obamacare policies provide, specifically whether deductibles are too high and whether networks of doctors and other providers are too narrow.

Success can be judged in three main areas: the insurance industry, the consumers, and broader society. For now, insurers are not voicing complaints about Obamacare, which is important because 2015 premiums will based, in part, on how well enrollments match companies’ projections. “I’m very optimistic as to where we are,” WellPoint (NYSE:WLP) executive Ken Goulet told investors at a March conference. He also noted that premiums would slightly increase next year because some government funding will decrease in 2015. Other insurers had indicated a similar reality, although some are relying on the little known off-exchange insurance market to broaden their base.

As for consumers, opinions are much more mixed. One reason opinions are so divided about the Affordable Care Act is because of the simple fact that the healthcare reform impacts the lives of individuals in different circumstances very differently.

How much an individual’s insurance costs will change because of the health care reform depends on a whole host of factors; it depends on age, current health status, state of residence, and of course whether the individual (or household) was insured before purchasing a policy via the Obamacare-mandated insurance exchanges. For example, those who are uninsured and have a preexisting condition will likely pay less for coverage than they would in the current private market; without accounting for subsidies, those who uninsured but young and healthy will likely pay more; those who are insured through their employer will likely experience few changes; and some 13 million Americans who are currently uninsured will pay little to nothing because they will become eligible for Medicaid. Plus, a vast majority of those buying plans on the individual exchange — 60 percent of the 29 million people who could make up the health insurance exchanges, according to the Kaiser Family foundation — will receive subsidies of varying amounts to make insurance more affordable.

But how society as a whole will judge the reform will largely depend on whether Obamacare can significantly reduce the number of uninsured Americans. Official numbers have yet to be released, but Gallup-Healthways Well-Being Index indicated that the healthcare reform law making insurance more affordable, with the number of uninsurance rate falling from an all time high of 18 percent in the third-quarter of 2013 to 15.6 percent in February.

But even in 2018 — when Obamacare is fully implemented and the projected 25 million have obtained insurance through the exchanges and 55 million via Medicaid — there will still be 30 million Americans uninsured, according to the nonpartisan Congressional Budget Office. Many of those who remain uninsured will be undocumented immigrants or low-income residents of states that did not expand Medicaid.

More From Wall St. Cheat Sheet:

Follow Meghan on Twitter @MFoley_WSCS