We still don't know how well Obamacare is working.
There's a lot we do know. We know that about 2.1 million people have signed up for private insurance through the health care law's exchanges and that about 25 percent of them are young adults. And we know that nearly 2 million more people have been deemed eligible for Medicaid.
So, the Affordable Care Act is definitely getting people covered, and enrollment is improving by leaps and bounds. But there are still several big, open questions—and when the open-enrollment period closes, it will be impossible to evaluate the law's first year without answering them.
How many uninsured people are getting covered?
Remember the whole uproar over canceled insurance plans in the individual market? Those people—we never got a solid count, but it was in the millions—mostly moved into Obamacare's exchanges, along with people who were uninsured.
So, 2.1 million people have selected a plan, but how many were previously uninsured, and how many are simply buying a new plan because their old one was canceled?
The Affordable Care Act wasn't designed to simply cover millions of people. It was designed to reduce the number of uninsured by millions of people (14 million in the first year, according to the Congressional Budget Office). To know whether the law is meeting that goal, we'll have to know how many enrollees were previously uninsured.
The Health and Human Services Department hasn't released that information for the 36 states where it is running the insurance exchanges, although officials said they'll try to have that answer at some point.
In New York, only about 45 percent of people who have enrolled so far were previously uninsured, meaning that more than half of the state's enrollees were changing their coverage, rather than gaining it.
How many people actually have coverage?
HHS defines a person as "enrolled" once they've gone through the application process, been approved, shopped, and selected an insurance policy. But consumers aren't truly enrolled—they don't have insurance they can use—until they pay their first month's premium. And we don't know how many people have done that.
Especially in the early days of enrollment, HHS's definition made sense: Who would pay a premium in October that wasn't due until December, for coverage that didn't start until January? HHS says it's still using the same definition because people won't pay their premium until it's due.
Even so, you're not covered until you pay your first premium. So, the 2.1 million people who have picked a plan might not all have coverage. That doesn't change the enrollment trend line; as one measure of enrollment rises, the other does too. Presumably, most people who pick plans go on to pay the premiums for those plans.
Still, to ultimately know how many people truly gained health insurance through Obamacare, we'll need to know how many people went all the way through the process.
Are healthy people signing up?
There's been an intense focus on the number of young people who are signing up for coverage (about 25 percent so far, which is not amazing but not terrible). That's not because young people are inherently more desirable customers; it's because age is a rough stand-in for health status.
Getting healthy people into the system is the key to avoiding major premium hikes next year. But no one really knows how healthy enrollees are, so age is used instead as a barometer. A 25-year-old is statistically more likely to be healthy than a 50-year-old. But, of course, there are exceptions. Enrolling a huge number of young people won't actually keep premiums low if they all turn out to be sick.
Because it's no longer legal for insurers to charge higher premiums because of a preexisting condition, the application for Obamacare coverage doesn't ask about previous health issues. So we won't know the breakdown of healthy versus sick for a long time—not until people start filing claims and insurers get a sense of their costs. Until then, age is the only guide, flawed as it is.
This article appears in the January 15, 2014 edition of NJ Daily.
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