Sign-ups for private insurance through Obamacare
were “on track” to hit seven million yesterday, the last official
day of open enrollment under the law, multiple White House
officials
tell the Associated Press.
The political narrative from here is easy to predict: a
come-from-behind victory that many thought was doomed. But in many
respects, it puts us right back where we started—with critics
pointing out its problems, supporters touting its successes, with
Democrats attached to the law and all its flaws, and with
Republicans adrift, lacking unified plans of their own.
It’s not clear exactly what the final sign-up totals are. Some
reports suggest that the seven million mark has already been
crossed, and that the final figure might be even higher once
state-based exchanges are factored in. But even if the seven
million sign-ups figure includes a few expected sign-ups through
the special enrollment period that begins today for people who
attempted to enroll but for whatever reason could not, it’s clear
that the last-minute surge in sign-up activity is huge. More people
appear to have signed up for insurance through the health law in
the last five days of March than in the entire month of
February.
Actual enrollment will be significantly lower due to
non-payment: Between 15 and 20 percent of the people who’ve
selected a plan in an exchange, and thus been counted as a sign up,
probably won’t end up paying the first month’s premium. Non-payment
in later months will result in further attrition.
Even still, the end result will be far more robust enrollment
than was widely predicted even just a few weeks ago. (Avalere, a
health care consulting firm that’s been tracking activity in the
exchanges, predicted in mid-March that sign-ups would be
just 5.4 million at the end of the month.) As a result, the
potential problems associated with low national enrollment are
unlikely to materialize.
The White House will no doubt tout this as a victory. But if
anything, it reveals the goal-shifting rhetorical games the
administration has played with the law over the last six months. In
September, just before the exchanges launched, Health and Human
Services Secretary Kathleen Sebelius said that success was signing
up at least 7 million people for coverage by the end of March. By
January, with a buggy website and enrollment lagging, White House
Press Secretary Jay Carney was backing off of that claim,
suggesting that 7 million had never really been the goal. But the
celebrations today—the administration’s top technology staffer
literally broke out the champagne at 12:01 last night—make it
pretty clear that 7 million really was the goal all along.
The administration also got the month-by-month totals wrong,
which is one reason why few people expected a late-breaking sign-up
surge of this size. Early
projections by the administration expected that about 1.8
million people, or 20 percent of the total, would sign up in March.
Instead, almost 3 million people ended up signing up in March.
Hitting the seven million mark is more of a
vindication for the Congressional Budget Office (CBO), which
initially predicted that about seven million would be covered
through private plans in the exchanges this year. What we still
don’t know, however, is how well the CBO fared on two other
important questions: What percentage of the people covered through
the exchange are young and therefore relatively healthy, and what
percentage of the people covered were previously insured? Early
indications are that the exchange population may be older (and
presumably sicker) and
significantly lighter on previously uninsured beneficiaries
than CBO expected.
To a great extent, then, this is all just an expectations game.
Seven million sign-ups is a seen as a big, unexpected victory in
the sense that, after wildly lowering expectations by botching the
exchanges, the administration managed, at the last minute, to
achieve its original headline sign-up goal. The law ended up doing
at least some of what most people expected it would do.
So in some sense what the end of open enrollment does is reset
the Obamacare debate. Critics who had problems with the law before
the exchanges failed, and before sign-ups started to lag, will
still oppose the law for most all the reasons they did for the
three years when almost everyone assumed that of course Obamacare
would expand health insurance coverage. Obamacare supporters,
meanwhile, will keep supporting the law for all the reasons they
did before.
It’s the same old back and forth—but with one major difference.
Now millions of people have health coverage through the law.
Yes, the coverage may be frustrating, and yes, some of those
people, perhaps a very large percentage, were previously insured in
the individual market. And some may drop their coverage by not
paying premiums, or by opting out if rates go up next year. But
what matters is that Obamacare is now the vehicle by which millions
of people have health coverage. Very few of them are likely to want
that taken away.
That will make the Republican message of repeal without a
viable, coherent replacement much more difficult to sustain. This
was always going to be a problem for the party, which has lacked a
unified, coherent strategy on health policy throughout the Obama
era. But the failure of the exchanges, and the slow start to the
sign-up process, seemed to convince many in the GOP that it was a
problem they would never have to face.
I wrote about this a few months ago in a piece called “After
Obamacare” for Reason’s print edition. When I pitched
the piece in September, before the exchanges crashed, I assumed
that it was a problem Republicans would start to face before the
end of 2013. But as I reported through the end of
October, when most exchanges were essentially non-functional, it
became clear that the GOP had decided that there was no problem.
Obamacare was failing, and that was all they needed to say. As one
House GOP staffer told me at the time, “There’s just no appetite to
lay out an entirely new agenda of ideas.” The entire focus would be
on “expanding existing criticism” and “continuing to bludgeon the
administration” over problems with the current law. “If Republicans
were interested in fixing health care, they would have been talking
about it much earlier,” the staffer said. “They weren’t.”
Obamacare’s obvious failures gave Republicans an excuse to avoid
the hard and divisive work of figuring out what sort of health
policy they actually favor. But that excuse won’t hold up much
longer.
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