Why Obamacare Numbers Don’t Really Matter

WASHINGTON, DC - OCTOBER 29: House Ways and Means Committee Chairman Dave Camp (R-MI) presides over a hearing about the implimentation of the Affordable Care Act in the Longworth House Office Building October 29, 2013 in Washington, DC. Centers for Medicare and Medicaid Services Administrator Marilyn Tavenner is the first Obama Administration to testify before Congress since the troubled launch the federal exchange website. 'I want to assure you that Healthcare.gov can be fixed, and we are working around the clock to give you the experience that you deserve,' she said.
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Sam Baker
Nov. 5, 2013, 3:44 p.m.

There’s one small prob­lem with the Obama­care en­roll­ment fig­ures the Obama ad­min­is­tra­tion is un­der so much pres­sure to re­lease: They’re nearly use­less.

Law­makers, re­port­ers, and out­side stake­hold­ers have been beat­ing down the doors at the Health and Hu­man Ser­vices De­part­ment to find out how many people have signed up for in­sur­ance through Health­Care.gov. That num­ber will be re­leased next week, Cen­ters for Medi­care and Medi­caid Ser­vices Ad­min­is­trat­or Mar­ilyn Taven­ner told a Sen­ate com­mit­tee on Tues­day.

Her prom­ise didn’t stop House Ways and Means Chair­man Dave Camp, R-Mich., from is­su­ing a com­mit­tee sub­poena Tues­day de­mand­ing the en­roll­ment data by Fri­day. House Over­sight and Gov­ern­ment Af­fairs Com­mit­tee Chair­man Dar­rell Issa, R-Cal­if., has also sub­poenaed the data.

But simply know­ing the num­ber of people who have signed up — even though that’s the num­ber every­one has been clam­or­ing for — isn’t very in­struct­ive, health care ex­perts say.

“It just doesn’t tell you the real story,” said Aus­tin Frakt, a health care eco­nom­ist at Bo­ston Uni­versity.

For starters, the num­ber is sure to be small. Demo­crats an­ti­cip­ated low take-up in the first month, and they have ac­know­ledged that Health­Care.gov’s tech­nic­al prob­lems will make Oc­to­ber’s num­bers even lower than ex­pec­ted. Re­pub­lic­ans might be able to crow over a small num­ber of en­roll­ments, but it won’t be a sur­prise.

Moreover, fo­cus­ing on the total num­ber of en­rollees leaves oth­er im­port­ant ques­tions un­answered. Obama­care’s suc­cess will de­pend not only on how many people en­roll, but also on who they are and where they sign up — in­form­a­tion a top-line en­roll­ment fig­ure won’t ne­ces­sar­ily provide.

The ad­min­is­tra­tion’s goal is to en­roll about 7 mil­lion people in the first year, and about 40 per­cent of those en­rollees need to be young, healthy con­sumers. Bring­ing young people in­to the sys­tem is crit­ic­al to keep­ing premi­ums low and avoid­ing an in­sur­ance “death spir­al.”

Hit­ting that mix across 7 mil­lion Amer­ic­ans isn’t good enough, though. Each state has to get the right ra­tio in its own in­sur­ance mar­ket.

“All of this is very state-spe­cif­ic on how it plays out,” said Ed­win Park, vice pres­id­ent for health policy at the Cen­ter on Budget and Policy Pri­or­it­ies.

The 36 states us­ing Health­Care.gov are of­ten lumped to­geth­er be­cause their ex­changes are all run by the fed­er­al gov­ern­ment and they’re all be­hold­en to the same broken web­site. Count­less re­port­ers and Re­pub­lic­ans have pressed HHS for en­roll­ment fig­ures for the fed­er­ally run ex­change, as if it’s one unit.

But each state does still have its own in­sur­ance mar­ket and its own risk pool. En­rollees aren’t pooled with any oth­er state, wheth­er they run their own ex­change or not.

Sty­mied by dug-in Re­pub­lic­an gov­ernors, the White House and its al­lies have fo­cused their out­reach cam­paigns on the states with the largest and young­est un­in­sured pop­u­la­tions, namely Flor­ida and Texas.

But a suc­cess­ful en­roll­ment cam­paign in those states doesn’t af­fect wheth­er smal­ler states are at risk for un­even en­roll­ment and high­er premi­ums. Get­ting things right in Texas, for ex­ample, doesn’t make life any easi­er in Ok­lahoma. And know­ing how many people have en­rolled na­tion­wide won’t help in­surers in Ok­lahoma meas­ure their risk.

“Premi­ums and all the dis­cus­sion of rate shock — all that is very state-spe­cif­ic,” Park said.

A na­tion­wide en­roll­ment total, pulling to­geth­er all 50 states, would give the health care world a sense of “how far be­hind we are” be­cause of Health­Care.gov’s woes and the tech­nic­al prob­lems with some of the 14 state-run ex­changes, Frakt said. Bey­ond that, he said, it’s all but use­less. One total for the 36 states us­ing Health­Care.gov wouldn’t be much bet­ter.

HHS hasn’t said yet wheth­er it will re­lease a state-by-state break­down next week — or wheth­er it will provide de­tails about who has signed up in each state. Of­fi­cials have said dur­ing brief­ings with the press that, while they un­der­stand the de­sire for de­tailed break­downs based on age and oth­er factors, their primary fo­cus now is simply on put­ting to­geth­er an ac­cur­ate total.

Without all of that in­form­a­tion, next week’s hotly an­ti­cip­ated fig­ures may not live up to the hype.

“Every­one wants to make a snap judg­ment on how this is go­ing to go, but it’s really too early to say. You can’t tell for a while, un­til you see in­surers’ ex­per­i­ence with 2014 en­rollees,” Park said.

Elahe Iz­adi con­trib­uted


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