Many of these will not finalize their paperwork until April 15, and many more might not pay their premiums.
Nonetheless, given the underwhelming rollout of Healthcare.gov, and well-funded campaigns in some states to discourage enrollment, the number is impressive. But the rest of the story is more important.
In coming weeks, these questions will be answered:
How many of these new enrollees will actually pay their premiums next month and be insured?
Are the new enrollees healthy or sick and in need of medical attention? How will the delivery system respond to these needs?
Did the penalty induce enrollment, or were other factors more important to individuals? Was it the attractiveness of subsidies or something else?
How will employers that provide health coverage assess the viability of health exchanges in their benefits strategies? Can these exchanges serve as a viable marketplace for employee insurance purchases (and allow employers to shift purchasing responsibility to their employees)?
Will troubled state exchanges (like Oregon, Maryland and others) try to fix their platforms, outsource to successful state exchange operators (like Kentucky/Connecticut) or invite the federal government to take over? What’s the long-term plan for the 14 state-run exchanges, and how will they be funded? And what’s next for Healthcare.gov? Is it fixed?
What is the long-term impact of health exchanges on the private health insurance industry? Is it a critical marketplace for their products? What’s the future of the individual insurance market?
And was the goal for health exchange enrollment—‘to reduce the ranks of the uninsured’—achieved if it turns out a significant majority of the new enrollees were previously covered?
No doubt, the muscle of the administration in tandem with efforts in many states contributed to the avalanche of late enrollment in March. Skeptics about the Affordable Care Act will likely discount the effort, noting it’s too soon to know the full impact of the enrollment push.
And proponents are unlikely to say “I told you so” because they’re are sensitive to the political risk associated with support of the ACA.
The enrollment milestone is important because it signals the continued viability of the Affordable Care Act and assures its prominence in the upcoming election cycle. But it’s only a small part of the story of health reform and the role private insurance plays. There’s much more to the story.
Paul Keckley, PhD is an independent health care industry analyst, policy expert and entrepreneur. Keckley most recently served as Executive Director of the Deloitte Center for Health Solutions and currently serves on the boards of the Ohio State University Medical Center, Healthcare Financial Management Leadership Council, and Lipscomb University College of Pharmacy. He is member of the Health Executive Network and advisor to the Bipartisan Policy Center in Washington DC. Keckley writes a weekly health reform newsletter, The Keckley Report, where an earlier version of this post originally appeared.