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 Health­ 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 Health­ 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 Health­‘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 Health­ 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 »
Clapper: ISIS Will Try to Attack U.S. This Year
1 days ago

“Leaders of the Islamic State are determined to strike targets in the United States this year,” Director of National Intelligence James Clapper told a congressional panel today. Clapper added that “al-Qaida, from which the Islamic State spun off, remains an enemy and the U.S. will continue to see cyber threats from China, Russia and North Korea, which also is ramping up its nuclear program.”

CBC PAC to Endorse Clinton This Morning
5 hours ago

The Congressional Black Caucus PAC will formally endorse Hillary Clinton this morning, and “nearly a dozen CBC colleagues will descend on” South Carolina next week in advance of that state’s important primary. Rep. Jim Clyburn (D-SC), the highest ranking black member of Congress, reversed his earlier position of neutrality, saying he’ll make a decision “later in the week.” Rep. Keith Ellison (D-MN) has pointed out that the CBC PAC is not the same things as the CBC itself, while the Intercept notes that 11 of the 20 board members of the PAC are lobbyists.

Senate Votes 96-0 to Sanction North Korea
4 hours ago

In a unanimous vote Wednesday night, the Senate echoed the House’s move last month to stiffen sanctions against North Korea. The bill “would sanction anyone who engages in, facilitates or contributes to North Korea’s proliferation of weapons of mass destruction, arms-related materials, luxury goods, human rights abuses, activities undermining cyber security and the provision of materials for such activities.” Senate Democrats said they expect the president to sign the bill. In related news, after South Korea suspended operations at a jointly run power station in the North, Pyongyang declared the area a military zone and cut off a hotline between the two countries.

How Large Is Hillary Clinton’s Delegate Lead?
4 hours ago

Three hundred fifty-two, thanks to superdelegates pledged to Clinton, and the vagaries of the delegate allocation process in early states. Not bad, considering her results have been a virtual tie and a blowout loss.

RNC Chief Would Welcome Bloomberg
3 hours ago

“The lead­ers of the Re­pub­lic­an and Demo­crat­ic na­tion­al com­mit­tees on Wed­nes­day weighed in on the pro­spect of an in­de­pend­ent pres­id­en­tial run by” former New York City May­or Mi­chael Bloomberg (I). “DNC Chair­wo­man Debbie Wasser­man Schultz sug­ges­ted that the former New York City may­or’s pri­or­it­ies are already ‘well cared-for’ in the Demo­crat­ic plat­form, while RNC lead­er Re­ince Priebus wel­comed the idea, say­ing Bloomberg would si­phon off votes from the Demo­crat­ic can­did­ate.”