OP-ED

7.1 Million. Will the Obama Administration Regret Today’s Announcement?

Politics is about expectations.

The Obama administration blew the doors off Obamacare’s enrollment expectations this week and scored big political points.

But in doing so, they may have set Obamacare’s expectations going forward at a level that can only undermine their credibility and that of the new health law.

What happens when the real number––the number of people who actually completed their enrollment––comes in far below the seven million?

What happens when the hard data shows that most of these seven million were people who had coverage before?

What happens when it becomes clear that the Obamacare insurance exchanges are making hardly a dent in the number of those uninsured?

Yesterday, the Los Angeles Times reported that the non-profit Rand Corporation estimated that two-thirds of the first six million people to enroll in Obamacare were previously insured––only two million were previously uninsured.

If all of the one million people who signed up in the last week were previously uninsured, that would mean that only three million previously uninsured people have purchased coverage in the government-run exchanges.

Rand also estimated that about nine million people have enrolled directly with the insurance companies, bypassing the government-run exchanges. But Rand also reported that the vast majority of those were previously insured.

If 20% do not pay, as has been the case since Obamacare launched, then the real Obamacare exchange enrollment number is about 5.7 million.

According to the March report from the Obama administration, 83% of those signing up were subsidy eligible.

If 83% of those 5.7 million were subsidy eligible, then about 4.7 subsidy eligible have signed-up in the first open enrollment. The Kaiser Family Foundation has estimated that 17.2 million people were subsidy eligible when the new health law launched.

That would mean that only 27% of subsidy eligible people have enrolled––and 73% of those who were subsidy eligible have not.

By celebrating seven million enrollments, the administration has set some pretty high expectations: That Obamacare is making a huge dent in the number of those who were uninsured.

But it would appear that is not the case and they will have to manage a steady flow of hard data that will undermine today’s celebration––in an election-year.

Of course, these are all estimates. The Obama administration could very quickly report the hard numbers on just how many people enrolled and paid. They could also very easily and quickly give us hard numbers on just how effective Obamacare has been in reducing the number of those uninsured.

Robert Laszewski has been a fixture in Washington health policy circles for the better part of three decades. He currently serves as the president of Health Policy and Strategy Associates of Alexandria, Virginia. You can read more of his thoughtful analysis of healthcare industry trends at The Health Policy and Marketplace Blog, where this post first appeared.

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22 replies »

  1. I would say likely not. The Exchange plans have quasi-Medicaid narrow networks. They are NOT better than what many if not most people previously had.

  2. Tightened networks, LOL. The understatement of the year. The networks are pretty much quasi-Medicaid, most leaving out cancer centers and research/teaching hospitals, plus many providers thereof.

    You cannot compare Exchange plans with plans that were available in 2013. They are not the same plans.

    And I didn’t bother reading the rest of your post. No doubt it was similar tripe.

  3. Actually 7.1 million people signed up for ACA but I’ll bet you that the number will reduce after the account reconciliation between the government and the insurance companies. This is because it is not all 7.1 million people that signed up will actually pay for it. Looking at the present income situation of many so called middle class group, it will be very difficult for those making $11,490 or more (single) or $15,510 or more (married couple) with deductible of $6000 annually, to come by with a premium of $330.00 every month. Well, a choice has to be made on whether one should pay premium or rent every month. I still do not see Affordable Care Act to be affordable for the income group mentioned earlier. This also applies to the group with higher income, because the higher the household number, the more the premium.

  4. Bob L said, reform couldn’t pass without bring in the Republicans. Baucus tried hard to do that, and it’s beyond clear that no Republican would have ever supported it–even ones like Snowe who were quitting. It passed anyway.

    Bob L said that we’d see massive rate shock. Instead plans tightened networks are rates were in general lower than they had been before.

    Bob L said that the web site debacle meant it would never work and we’d go into an insurance death spiral. The web site launch was a cock up, but Medicaid expansion (where allowed) has more or less been OK, and the web site now more or less works (outside Oregon & Maryland)–backing my argument for one Federal exchange, which you may remember was in the House bill before we ended up being forced to take the Senate one.

    Bob L last week was on about the financial disaster for plans the very week Wellpoint raised earnings expectations because they had more enrollees.

    Because of the politics of the nation, the ACA is a ridiculous hodge-podge of a law requiring–you’ll remember– a) opt-in to what’s almost a social insurance program b) arbitrary tax (and now subsidy) distinctions between those who get insurance via and employer or not and c) arbitrary access to insurance depending on your income and which side of a randomly drawn line you live on for poor people.

    If this was a sensible country no one would have designed either the system we had or the ACA as the very trivial reform (which it is) to fix it. But if this was a sensible country the Senate would have been abolished in 1935 (or sooner).

    But given the hand they have, I’m not convinced the the Democrats have done that bad a job.

    And Bob L’s alternative of waiting for a grand coalition would have meant that we did NOTHING.

  5. The ACA seems to be batting about .500 in terms of those individuals who have been helped by the law, versus those who have been hurt by a worsening of premiums, networks, and in some cases deductibles.

    That is actually pretty awful for a social insurance program. However, the happiness or unhappiness of a few million persons on either side above will not change American society or American health care.

    I think that the real test will be what happens in the group insurance market, which is 6 times larger. The ACA has completely failed so far in encouraging large companies to expand insurance, ii.e. the 29 hours a week scandal, and further regulations will disrupt many small groups.
    In this area the ACA could bat in the .250 range, which is not even very good for a ball player.

  6. I’ll bet most of the people who signed up for ACA insurance, whether on or off the exchange, who were previously insured now have more comprehensive insurance than they had before though they may be paying more for it. On balance, I think they are net better off than they were before. Those who were previously uninsured because they couldn’t pass medical underwriting and were considered uninsurable but still haven’t enrolled at least have the peace of mind of knowing they can enroll in the future though they may have to wait for the next open enrollment period and pay the modest penalty in the meantime. I think they are also net better off than they were before.

    I always had good employer based health insurance and am now retired and on Medicare with a comprehensive supplemental plan to cover Medicare’s deductible and coinsurance. I’ve had my share of medical issues in the past and was glad that insurance was there to help pay the bills. Since I wouldn’t have wanted to face them without insurance, I don’t think anyone else should have to either. While I have my issues with the Obama administration, especially its regulatory apparatus, I think the ACA is a positive development, the botched launch notwithstanding. Moreover, I can say that as one who is affected by the new 3.8% tax on investment income that helps to finance it.

  7. Wrong about what, Matthew? The administration clearly had no idea what “reforming” a $1 trillion private insurance market entailed, and they still don’t.

    What was the goal? Reducing the number of uninsured? Making the overall population healthier? Reducing the growth in health costs?
    Not clear on any of these counts how much progress we’ve made, and like a couple of the people above suggest, we won’t know for years.

    There has been a lot of goal-post moving on the administration’s part, and a ton of spin control. This bill is still a huge albatross for the Dems, and it seems like the proximate goal of all the “Woo Hoo, We Got to 7 Million After All!” stuff is to stop Dems from running AWAY from ACA and keep the Senate.

  8. Latest ACA public polling (many grains of salt) has 49% in favor, 48% opposed, up from 40% – 57%.

    Ten years. In terms of the Triple Aim. Maybe, charitably 5, but I’m talking solid significant, durable improvement evidence. We have policy ADHD, though, we want instant gratification. We summarily declare large-scale reform initiatives “a total failure” after a year or 2. It is stupid.

    Should the GOP re-take the Senate later this year, ACA “repeal” could effectively become a reality.

    Maybe. Though, the Reep “adults” will surely know that letting the Tea Party mouth-breathers run riot could cost them in 2016.

  9. No, they won’t, anymore than they regretted, “We’ll see what’s in it when we pass it”, and “If you like your plan, you can keep it.” The hardcore stick-to-it at all costs attitude will not allow for any concession. They will use the 7 million as “see we told you it would work, nyah nyah nyah”.
    Oddly, still a majority of the population is still very much opposed, or at least suspicious of the ACA, despite the fact that some people may have truly benefited and are grateful.
    I agree, it may take more than a year to see the total effect, but probably not 10.

  10. “But the real effect of this law will emerge only after 1 year.”
    __

    10 years. If it survives that long. SCOTUS just struck down aggregate campaign donation limits (McCutcheon v FEC). One Dollar, One Vote could put the Senate back in GOP control.

  11. I agree. Let’s scrap it and go the full socialization. The government should nationalize all private clinics, hospitals and insurance companies and their assets. We need a civil service, non-profit health service. That would be the epic win!

  12. Let the Analysts on both sides start their work. We will see some detailed true analysis, some general comments such as what Arthur says. But the real effect of this law will emerge only after 1 year.

  13. Three rules when discussing anything obamacare:
    1) It was never meant to work,
    2) It cannot work,
    3) When any other thoughts and distractions enter your mind, remember rules #1 and #2.

  14. Being ‘subsidy eligible’, as Robert L. uses the term, covers a lot of ground.

    With the right income and in the right state, you might get a $400 a month subsidy and owe $56 for decent insurance.

    With the wrong age and income, you might get a $70 subsidy and still owe $400 cash for your insurance.

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