The Obamacare Enrollment Crash Is Coming

National Journal
Sam Baker
Feb. 19, 2014, 3 p.m.

Obama­care’s en­roll­ment num­bers are sur­ging — for now.

After a dis­astrous launch, the law’s back­ers are breath­ing a sigh of re­lief as en­rollees flock to its in­sur­ance ex­changes. But the totals are built on a shaky found­a­tion, and at some point soon, the ex­change en­roll­ment fig­ures are go­ing to fall, per­haps by more than 1 mil­lion people.

Right now, the ad­min­is­tra­tion is count­ing the total num­ber of people who have se­lec­ted an in­sur­ance policy un­der the law, rather than the num­ber of people who’ve paid for it.

But at some point, likely this spring, the ad­min­is­tra­tion will be forced to dis­close how many people are ac­tu­ally pay­ing their premi­ums — a more ac­cur­ate, yet un­doubtedly lower count of who ac­tu­ally got in­sured un­der the Af­ford­able Care Act.

About 20 to 30 per­cent of people who se­lec­ted a plan did not make their first pay­ment, ac­cord­ing to an­ec­dot­al es­tim­ates from in­di­vidu­al in­sur­ance com­pan­ies. Those num­bers aren’t of­fi­cial or fi­nal, and could im­prove — but however they end up, that’s the real meas­ure of Obama­care’s first-year suc­cess.

It’s hard to see the re­vi­sion do­ing any real dam­age to the law’s long-term pro­spects for sur­viv­al, or its po­ten­tial to grow. And in real-world im­pact, it doesn’t mean that any­one has lost their in­sur­ance; it simply means they signed up to buy a plan that, for whatever reas­on, they’re not go­ing to ac­tu­ally buy.

Polit­ic­ally, however, it will be a Re­pub­lic­an field day, as it hands Re­pub­lic­ans a fresh at­tack — one that un­der­cuts Demo­crats’ emer­ging suc­cess story of high en­roll­ment — and could put vul­ner­able Demo­crats back on the de­fens­ive over a law they’re try­ing not to talk about.

The Health and Hu­man Ser­vices De­part­ment’s latest up­date re­por­ted that 3.3 mil­lion people had se­lec­ted an in­sur­ance policy on the law’s new ex­changes by the end of Janu­ary. It was a pos­it­ive re­port by al­most any stand­ard, and puts en­roll­ment on track to hit 5 to 6 mil­lion by the time the win­dow closes in March.

Demo­crats have touted the totals as a sign that the law is work­ing, des­pite Re­pub­lic­an in­transigence and early tech­no­logy dis­asters.

But if the early in­dic­a­tions hold and the more ac­cur­ate en­roll­ment met­ric shaves 20 to 30 per­cent off the ini­tial num­bers, it will be a pain­ful shift for Demo­crats. At cur­rent levels, it takes en­roll­ment from 3.3 mil­lion down to about 2.6 mil­lion. If, hy­po­thet­ic­ally, 6 mil­lion people choose a plan by the end of March, real en­roll­ment would be closer to 4.8 mil­lion.

That’s enough for the new in­sur­ance mar­kets to be sus­tain­able, health care wonks say. The Af­ford­able Care Act is already here to stay.

Still, the day the White House cuts its own en­roll­ment totals by 20 per­cent is prob­ably not go­ing to be a very fun day for vul­ner­able Demo­crats, who are already frus­trated with the ad­min­is­tra­tion over the delays and tech­nic­al head­aches that have riddled the im­ple­ment­a­tion ef­fort.

Re­pub­lic­ans are try­ing to keep the de­bate fo­cused on Obama­care, and to paint the law as not liv­ing up to ex­pect­a­tions. And a down­ward re­vi­sion in en­roll­ment — even one done in the name of more ac­cur­ate data — will put the law fur­ther away from the ini­tial tar­get of en­rolling 7 mil­lion people this year.

But there’s no way around it for Demo­crats. Party strategists say the White House has to re­lease the more ac­cur­ate fig­ures once it has them, and that the best strategy for vul­ner­able sen­at­ors is simply to ride out an­oth­er GOP at­tack.

“The White House has got to be as trans­par­ent as pos­sible from here on out. The last thing they can af­ford to do is get tripped up,” said Jim Man­ley, a Demo­crat­ic strategist and former aide to Sen­ate Ma­jor­ity Lead­er Harry Re­id.

Demo­crats don’t ex­pect the en­roll­ment re­vi­sion to do long-term polit­ic­al dam­age. Sign­ing up 4.8 mil­lion people in­stead of 6 mil­lion people is still sign­ing up 4.8 mil­lion people, they ar­gue.

“Over­all, I know there is a con­stant search for less than good news in the Health­Care.gov arena, but if you look at the data re­por­ted, it is over­whelm­ingly pos­it­ive, and the pre­dic­tions of fail­ure and doom and gloom that we saw — un­der­stand­ably, per­haps, giv­en how rocky the start was in Oc­to­ber and Novem­ber — have all come to naught,” White House press sec­ret­ary Jay Car­ney said last week when asked about people who had not paid their premi­ums.

There prob­ably wasn’t any way for Demo­crats to avoid the box they’re in now.

Even be­fore the Health­Care.gov launch made sign­ing up al­most im­possible, the Cen­ters for Medi­care and Medi­caid Ser­vices had al­ways planned to define en­roll­ment based on the num­ber of people who se­lec­ted a plan, a CMS of­fi­cial said. The of­fi­cial said CMS knew there would be a lag in get­ting more-com­pre­hens­ive data from in­sur­ance com­pan­ies.

That lag time, though, has grown longer as a res­ult of Health­Care.gov‘s tech­nic­al prob­lems.

CMS is still build­ing the com­puter sys­tem that auto­mat­ic­ally pays in­surers and re­con­ciles en­roll­ment in­form­a­tion between car­ri­ers and the gov­ern­ment. It’s one of the back-end sys­tems that took a back seat as HHS struggled to re­pair the Health­Care.gov user ex­per­i­ence.

Al­though in­surers are get­ting paid through a work­around sys­tem, it only cap­tures con­sumers who get a tax sub­sidy to help pay for their cov­er­age — so it’s not a com­pre­hens­ive ac­count­ing of every en­rollee.

A full count of ac­tu­al en­roll­ment will be avail­able when that sys­tem is fin­ished, the White House has said.

{{ BIZOBJ (video: 4744) }}

What We're Following See More »
BACKING OUT ON BERNIE
Trump Won’t Debate Sanders After All
1 days ago
THE LATEST

Trump, in a statement: “Based on the fact that the Democratic nominating process is totally rigged and Crooked Hillary Clinton and Deborah Wasserman Schultz will not allow Bernie Sanders to win, and now that I am the presumptive Republican nominee, it seems inappropriate that I would debate the second place finisher. ... I will wait to debate the first place finisher in the Democratic Party, probably Crooked Hillary Clinton, or whoever it may be.”

AKNOWLEDGING THE INEVITABLE
UAW: Time to Unite Behind Hillary
2 days ago
THE DETAILS

"It's about time for unity," said UAW President Dennis Williams. "We're endorsing Hillary Clinton. She's gotten 3 million more votes than Bernie, a million more votes than Donald Trump. She's our nominee." He called Sanders "a great friend of the UAW" while saying Trump "does not support the economic security of UAW families." Some 28 percent of UAW members indicated their support for Trump in an internal survey.

Source:
AP KEEPING COUNT
Trump Clinches Enough Delegates for the Nomination
2 days ago
THE LATEST

"Donald Trump on Thursday reached the number of delegates needed to clinch the Republican nomination for president, completing an unlikely rise that has upended the political landscape and sets the stage for a bitter fall campaign. Trump was put over the top in the Associated Press delegate count by a small number of the party's unbound delegates who told the AP they would support him at the convention."

Source:
TRUMP FLOATED IDEA ON JIMMY KIMMEL’S SHOW
Trump/Sanders Debate Before California Primary?
2 days ago
THE LATEST
CAMPAIGNS INJECTED NEW AD MONEY
California: It’s Not Over Yet
2 days ago
THE LATEST

"Clinton and Bernie Sanders "are now devoting additional money to television advertising. A day after Sanders announced a new ad buy of less than $2 million in the state, Clinton announced her own television campaign. Ads featuring actor Morgan Freeman as well as labor leader and civil rights activist Dolores Huerta will air beginning on Fridayin Fresno, Sacramento, and Los Angeles media markets. Some ads will also target Latino voters and Asian American voters. The total value of the buy is about six figures according to the Clinton campaign." Meanwhile, a new poll shows Sanders within the margin of error, trailing Clinton 44%-46%.

Source:
×