Enrollment in the new marketplaces created by the Affordable Care Act appears to have passed the 7 million mark as traffic surged on the final day of open enrollment, according to administration officials. That would meet the initial projection from the Congressional Budget Office, a projection that was scaled back to 6 million after the botched rollout of healthcare.gov, the federally facilitated website used to sign up in 36 states, including Arkansas.
Many observers, even among the law’s supporters, doubted that the target was possible after the disastrous performance of the website in the early weeks of enrollment. While that remains an embarrassing unforced error with both political consequences and real harm to folks attempting to enroll, it appears more and more likely that it will end up being a footnote in the history of the law. A detour on the track, not a wreck of the train.
The final-day surge (compared by some to shopping on Black Friday or by one Utah state official to “trying to find a parking space at Walmart on December 23”) came despite the fact that the administration had given folks an extension to sign up. Whatever the final tally was at midnight last night, it will grow in the coming weeks.
In the grand scheme of things, the 7 million number isn’t very meaningful. It was a projection done by the CBO, their best guess on how enrollment would turn out — despite my headline, it was never really a target with any tie to the functionality or efficacy of the law. Moreover, the big national numbers aren’t the real story. Each marketplace in each state (and the District of Columbia) has its own population. The size of each — and more importantly, the mix in terms of health — is very different state by state. The implementation of Obamacare is often reported as one big story, but it’s really 51 stories. To take our own example, Arkansas has seen enrollment lag in the Arkansas Health Insurance Marketplace, at least based on numbers released through March 24. Yet the state should have a robust population on the Marketplace thanks to the unique private option policy, which will put more than 100,000 Medicaid beneficiaries into the market. Those are the sorts of state-specific nuances that the big headline number cannot capture.
Critics will note, fairly, that the number includes people who have not yet paid their first premium. If people never pay up, they won’t be covered. Health and Human Services Secretary Kathleen Sebelius said that 80-90 percent of enrollees have paid a premium. If 15 percent never pay, the coverage expansion achieved yesterday will be more like 6 million, not 7. In Arkansas, around a quarter of the enrollees (through March 24) are not yet covered because they have not yet paid the first month’s premium.
All of those caveats notwithstanding, reaching 7 million has long been a symbolic target, a big-picture signpost that the law was on its intended path forward. It is symbolic, too, because of the gleeful certainty with which the law’s critics declared that it was out of reach. It is symbolic because the law’s critics used to say that this was a product that nobody wanted. It is symbolic because the law’s critics once trumpeted the early low enrollment numbers, convinced of their train-wreck prophecy, convinced that the law was doomed.
For all of the hollering, Obamacare enrollment ended up right where the CBO thought it would as the law was implemented (and better than the CBO projected more recently). That warped graphic I posted yesterday from Fox News is a perfect illustration of a talking point and a narrative collapsing, even as its purveyors try to hold on tight.
But if the real story about Obamacare is a lot more complicated than the sign-up figures indicate, it’s also a lot more complicated than the conservative caricature of Obamacare would have you believe. The Affordable Care Act has unleashed a great many changes—some good, some bad, some in between. And it’s going to be a long time before there’s enough evidence to assess them carefully. But the available data points offer hints about what is happening. And while they don’t add up to a clear, definitive vindication of the law, they are enough to justify some real optimism—the kind that hasn’t been possible since October 1, the day healthcare.gov launched, crashed, and nearly took the whole liberal cause into cyberhell with it.
People are signing up for health insurance they need. The law, despite the fantasies of its political opponents, will not simply collapse. There are big open questions going forward, but Obamacare appears to be making progress on reducing the number of uninsured people in this country.
That’s true in Arkansas, where 150,000 people and counting have gained coverage via the private option. Only a little more than 30,000 non-private-option consumers (see here for an explanation of those two separate groups) had signed up on the Arkansas Health Insurance Marketplace as of a week ago, but the Democrat-Gazette reports this morning that, as with the rest of the nation, the state saw a surge in the final days of open enrollment.
Whatever the final tally in Arkansas and the rest of the nation, opponents of Obamacare will have to come to terms with a new political reality: repealing the law will mean taking those people’s health insurance plans away.