Numbers We’d Rather Be Talking About

You’ll be hearing a lot about the number six point five million over the next few days.

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 john@thehealthcareblog.com. Follow him on Twitter @THCBstaff.

11 replies »

  1. I’ll add another group, the “Shell Shocked”, those who actually use the system but find out the high deductibles mean they are still paying out-of-pocket for all but the most serious illness – one that will mean they can’t work or will miss so much work that the ability to keep paying for premiums will be close to impossible. They’ll find that week’s worth of savings will not go far.

  2. This is the proof once again that the government cannot do anything right.
    California still has numerous problems. We are seeing approx. 4.2 million people signing up, but others electing forego coverage. BTW. Those numbers are more than triple the number signing up. I guess it is time to
    end Obismal Care…

  3. John,

    Good post.

    There are going to be enough facts, factoids, truths and truthiness for everyone to claim “victory”. 10 years from now, we MAY actually know what happened.

    The one thing that I am sure of is that: It ain’t going to be as good as the proponents claim, and it ain’t going to be as bad as the opponents say.

    In the meantime, we are privileged to watch the most complex re-arrangement of the deck chairs on the Titanic in our time.

  4. Let’s not forget the number of people who will have insurance for the first time, but have virtually no idea what type of plan they’ve purchased, or how it works.

  5. Good post, John.

    We keeping calling this “insurance.” It’s mostly yet another byzantine permutation of no-value-adding “pre-payment” bureaucracy.

  6. Pundits on both sides of the isle will be talking, debating, shredding the numbers. It will settle down. We will know a clearer picture regarding numbers in a few months.

    We should be more interested in implications of these numbers in a real sense – are people going to be happier? Healthier?

  7. Yaakov, you are absolutely right about the need for a new plan D for the uninsured.

    But could it ever have passed Congress, even the Democratic Congress of 2010, with an increase in federal income taxes? The increase would have had to reach down a lot lower than the $250,000 ‘floor’ of candidate Obama.

    The new Plan D would also look very attractive to persons with lousy insurance. New government plans (other than Medicare itself) have always had minefields of regulations to keep away people who have existing insurance. Abandoning these barriers would be a good thing, but is also expensive.

  8. The question that nobody wants to tackle is that, assuming the supporters of ACA really were primarily interested in giving more of the the uninsured health coverage, did it succeed by that narrow measure and was the ACA the best way to do it?

    Somewhere early in the process it seems this priority got lost in all the deal making with the special interests which expected to profit immensely from this, and who insisted on “mandates” built into the ACA specifically to protect their selfish interests.

    That is how we got QHP’s (qualified health plans – and thanks for forcing me to look that unidentified abbreviation up) with too many expensive bells and whistles, and which therefore cost too much for millions of people who earn a middle class income to afford, given the ACA’s subsidy structure.

    There was also no need to throw millions of people off of insurance plans they were perfectly happy with. Seems to me, if the new Obamacare plans are better, people would choose them without having to put a gun to their heads by cancelling their old plans.

    And why infuriate 10 million seniors by gutting their Medicare Advantage plans, and forcing them to lose access to their longtime doctors and the best hospitals in their area? Is that really making the nation’s health care any better?

    What would it have cost to leave the existing system alone and simply created an equivalent to a Medicare Plan D plan offering the uninsured, at a steeply subsidized price, coverage of up to 4 free visits to a hospital emergency rooms or urgent care centers a year, plus a catastrophic care plan. Keep it cheap (the politically correct word, I believe, is “affordable” – so excuse me) but no, don’t violate their civil liberties (I’m sorry Chief Justice John Roberts – you were wrong) by forcing them to buy it if they don’t want it.

    Then the country would pay for it with one new progressive federal tax on every taxpayer, earmarked to pay just for coverage of the participating uninsured and nothing else. No political picking of winners and losers allowed.

    I’ll bet it would have cost a lot less than the ACA; not taken four years and a huge new federal bureaucracy to put it in place, given basic and necessary insurance coverage to millions more of the people who really needed it and not started a bitter, partisan nationwide battle either.

    And then there is the Medicaid mess. What good does it do give millions more poor people through ACA access to over-regulated and underfunded Medicaid coverage that most of the better health providers won’t willingly accept? Why is it considered progress to create a second class health care system in this country? But forgive, me, I digress – that is a whole different discussion.

  9. I can see in the next few weeks the greatest argument between glass half empty and half full ever visited upon mankind since the Reformation.

    We will see the finest display of post hoc rationalization.

    The one thing we won’t be quibbling about are the numbers. Thank god!

    Grab popcorn and enjoy. It will be a treat!

  10. Haven’t read it, don’t know what’s in it. Lousy website rollout. Poor outreach.This is going to come back to haunt them. And latest polls show only 25 % of the US population in favor of it.
    Physicians are fed up, and I think patient will be too eventually. There were 40 million without insurance? Now how many of those have signed up?
    If this is such a great thing why do we keep postponing parts of it?
    People were not being turned away from ERs. Illegal, and no hospital would risk that liability.
    Yes, I am happy that poor people and pre-existing can now get help. I think it remains to be seen just how effective this law will be in terms of quality and affordable care.