Obamacare’s Website Is Working (Somewhat) Better—But It’s Still Going To Have a Tough Time Hitting Its Sign-Up Goals

Funny how quickly Obamacare data leaks when it’s
reasonably good news. During the initial days of Obamacare’s
launch, federal officials repeatedly refused to provide enrollment
data. Health and Human Services Secretary Kathleen Sebelius and
Press Secretary Jay Carney even claimed they didn’t have.

Leaked notes from the administration’s Obamacare “war room”
later revealed that just six people made it all the way through the
federal exchange system, which covers 36 states, on day one. And
despite the denials from administration officials, the low number
was known and discussed inside parts of the administration by the
second morning the exchanges were online. Eventually we found out
that during the entire month of October, just 27,000 people signed
up for health insurance plans through HealthCare.gov—a figure that
the administration waited until the middle of November to
release.

But now that the consumer end of the federally run insurance
portal is working somewhat better, sign-up data is leaking on a
daily basis. In the last three days alone, some 56,000 people have
picked plans through the site, including about 27,000 on Tuesday
alone, according to a
report in The Washington Post citing sources familiar
with the numbers.

Working “better” is, of course, a pretty low bar, since the
federal insurance portal was barely working at all for the month of
October. But there’s no question that this represents a meaningful
improvement in site performance, at least on the consumer side.

Yet these numbers don’t necessarily point to success for the
law. For one thing, it’s not certain that all of the people being
counted in these tallies will actually be enrolled. As The
Hill
noted yesterday when the first two days of sign-up numbers
leaked, these enrollees are “people who chose plans but had not
necessarily paid their first premium.” The (likely
administration-connected) sources tipping reporters to these
numbers say the administration is counting these individuals as
having enrolled. But as
a CNN story today points out, no one is actually enrolled
without paying the first month’s premium. So these numbers may be
overstating the true enrollment levels within the federal exchange
system.

Nor does this take into account the ongoing problems with
transmitting accurate enrollment information to insurers. Sources
told
The Washington Post earlier this week that roughly a third
of enrollments were affected by these errors. Insurers say that in
some cases, enrollment data isn’t being transmitted at all.

Even if you assume that everyone ends up enrolled, the current
trajectory probably doesn’t put the administration on track to
hitting its goal of enrolling seven million people in private
coverage through the law by the end of March.

At an average of about 19,000 sign-ups per day, the result would
be about 2.3 million enrollments in the federal system. State-run
exchanges will add to that total, but not enough to get it close to
the goal: California, the biggest of the states running its own
exchange, is only aiming to get 500,000-700,000 individuals signed
up by the end of March, and most of the other states are relatively
small.

Of course, enrollment almost certainly won’t proceed on a evenly
distributed basis. The experience of Massachusetts with Romneycare
suggests that there will be a
significant spike in enrollment right before the individual mandate
kicks in, although the enrollment numbers there are so low,
relatively speaking—just over 8,000 people enrolled in the final
month before the mandate kicked in—that it’s hard to draw a strong
conclusion about how much the Bay State’s enrollment patterns will
be replicated on the much larger national scale.

I would also expect that there’s a (smaller) surge of activity
during the early part of this month. The website is finally
performing well enough to be usable for many people; December 23 is
the (revised) deadline to get coverage that kicks in on January 1;
and Medicare private exchanges typically experience a spike in
enrollment during the week after Thanksgiving. My best guess, then,
is that we’ll see somewhat higher sign-up activity this month,
slightly lower numbers in January and February, and a big jump in
March. But since nothing on this scale has ever been tried before
in the U.S., no one really knows. But the point is that the
administration will need to significantly boost the average number
of sign-ups in order to meet their enrollment target. 

Finally, it’s worth remembering that the headline enrollment
total, whatever it turns out to be, isn’t the only number that
matters. As the administration has indicated repeatedly, it’s also
important that health plans manage to sign up the right demographic
mix, with enough young and healthy individuals to balance out the
older and sicker beneficiaries. Already, there are signs that young
adults are may spurn the law and its coverage scheme, with
more than half of young adults aged 18-29 disapproving of the
law, believing it will make their care more expensive, and saying
they are unlikely to enroll in coverage.

The administration, meanwhile, hasn’t released demographic
breakdowns of people who have signed up so far, which is telling
enough. Since enrollees have to provide their age and other
personal information, we know that the data on the composition of
the insurance pools exists. And since we know that good news leaks,
and bad news doesn’t, it’s probably safe to assume that whatever
information the administration has isn’t particularly
good.