Six point five million — or whatever the exact number turns out to be at the end of the day — being the number of people that the administration say signed up for Obamacare through the exchanges when open enrollment ends March 31st.
How meaningful the official numbers are will be open to debate. The bloviation factor will be in full effect. The critics will be downplaying the administration’s number, ACA supporters defending it. Data geeks-turned-media stars will explain what it all means.
Here’s a guide to some of the other numbers we should be talking about as we try to make sense of what’s really going on and what really happened during the Obamacare rollout.
FUDs: The number of people who are innocently living their lives thinking they have bought health insurance, but who, for one reason or another, be it technical glitch, bureaucratic incompetence or technicality – are going to wake up one morning not long from now and discover that they do not have health insurance.
And who one day soon will discover that they do not have health insurance. This is the group that causes people in Washington to lie awake at night; because they are going to complain – and complain loudly. While the talk from the administration to this point has been all tough, it seems logical to assume it will build an appeal mechanism that will allow FUDs back into the system. The early signs are that this is the case.
404s : The number of people / applications lost in the system, either as a result of the Healthcare.gov fiasco or because their application is sitting forgotten on somebody’s desk somewhere or on a laptop. Anybody who tried to log into Healthcare.gov at the height of the meltdown or who has gone back and forth with their insurance company over a bill gets it.
It is safe to assume that this is another number that keeps planners up at night. Let’s just say it is safe to assume that there are a lot of 404s.
CANCELS: The number of people who had their insurance plans cancelled by insurers on the grounds that they did not meet the standards set by the Affordable Care Act. In a way, being a cancel can be considered a badge of honor in the gamification of the healthcare system that is Obamacare.
UNCANCELS: The number of people who had their plans cancelled by the health insurers only to have them declared “uncancelled” by the Obama administration or their state. Nobody really knows how many uncancels there are. Don’t ask. Yes, it will take a really long time to sort out the uncancels from the cancels and the QHPs.
And you will probably want to shoot the person explaining it to you. In the gamification of the healthcare system, level ups go to people who have been cancelled, uncancelled and bumped.
BUMPS: The number of people who have been “bumped” out of network and are being forced to change doctors. What’s going on? In gamification terms, bumps make things more exciting. In real life, they suck. Getting bumped off a flight is annoying, getting bumped in the health care system is potentially life-threatening.
LIVES SAVED: As we speak Nate Silver or a smart person who looks and sounds a lot like Nate Silver is sitting at a computer in a darkened room somewhere trying to come up with a reliable quantification of the number of lives the Affordable Care Act has saved and will save by shielding people from the barbaric US healthcare system.
How would you go about coming up with that number? Would you look at people turned away from emergency rooms? Would you look at the number of preventable deaths under the old system? Would you total the number of deaths from cancer, heart attack and stroke? Compare mortality rates over the decade from 2004-2014 with those from 2014-2024? It will be long time before we have the data we need to really understand how well we’ve done.
You can forget the nonsense we’ve been hearing about Obamacare costing the lives of thousands of Americans by taking their health coverage away from them. There is a difference between losing your coverage temporarily because the system is in transition and losing it and knowing that you’ll never be able to get it back. Ever.
Calculated over decades to come the number of lives saved is likely to total in the thousands, if not the millions. And that will be the true test of the Affordable Care Act as a historical accomplishment for Barak Obama and his administration.
PRE-EXs: The number we should talking about is the number of people who’ve signed up for insurance under Obamacare who would have never been able to buy insurance under the old, evil healthcare system that discriminated against people with previously existing conditions like cancer, high blood pressure and HIV/AIDS. How many people with previously existing conditions have been able to get coverage under the new system ?
We know roughly how many people in the federal high risk-pool have bought insurance, but that’s not exactly scientific evidence of anything.
NETWORKS and DOCS: Once we figure out how many people have signed up for Obamacare we’re going to have to figure out what they bought. What kind of coverage is Obamacare providing? We won’t understand the new healthcare system we’ve built until we’ve mapped and understood the networks that are organizing under the new rules. How many docs and hospitals are participating in each?
What happens when you get cancer and you need to go to a specialist and find out that you can’t get in to see the doctor you need to see? What will the economic impact be on the hospitals and doctors operating. What will the impact on prices for consumers be? Now we get to find out.
YOUNG ADULTS: Based on early reports, there is reason to think this number was looking like it was going to be a lot lower than the administration wanted it to be, a fact which terrified the people at health plan responsible for managing risk.
On the other hand, there is also reason to think that people in this age group will do things at the last minute, because – well – that’s the way way they live their lives. It’s logical to think they’ll do things at the last minute. On the other hand, they may also decide to go download something from Netflix and blow the whole thing off. The young adults are fickle.
The shiny tech based enrollment system planners developed (yes, we are unfortunately talking about Healthcare.gov) was supposed to guarantee this group by reaching them where they live – online and through their mobile devices.
It turns out things are considerably more complicated than planners thought they were, as the people who start tech companies could have told them. It’s not enough to build a web site.
John Irvine is THCB’s executive editor. You can reach him by email at firstname.lastname@example.org. Follow him on Twitter @THCBstaff.