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Obamacare numbers coming in huge: Here's a guide to GOP excuse-making

March 31, 2014|By Michael Hiltzik
  • The surge is happening: Customers line up in Panorama City over the weekend to sign up for Obamacare.
The surge is happening: Customers line up in Panorama City over the weekend… (Irfan Khan / Los Angeles…)

Against all odds and expectations, enrollments in health plans qualified under the Affordable Care Act are surging Monday toward -- and maybe beyond -- the 7-million figure projected by the Congressional Budget Office before Oct. 1, when the open-enrollment period began. The deadline for starting enrollment applications for 2014 plans is midnight Monday.

The surge is creating a big problem for the "train wreck" narrative of Republican opponents of the ACA, who have been holding out hope for Obamacare's utter failure. So the excuse-making has begun. 

Before we examine those excuses: You will recall that the budget office reduced its projection of enrollments on individual insurance exchanges to 6 million earlier this year to account for the botched launch of healthcare.gov, the federal enrollment website. Enrollments blew past that mark days ago. If exchange enrollments meet or exceed the original projection of 7 million despite the loss of some six weeks in website functionality in October and November, that would be a testament to the public's latent desire for effective healthcare coverage. 

Photos: The battle over the Affordable Care Act

We won't know the final March 31 tally for days, possibly weeks, but that indispensable enrollment tracker Charles Gaba is projecting 6.78 million exchange enrollments, with a chance of topping 7 million. 

That figure covers enrollments in private healthcare plans via healthcare.gov and the individual websites offered by 14 states and the District of Columbia. As my colleague Noam Levey is reporting, the Rand Corp. estimates that another 4.5 million previously uninsured adults have signed up for Medicaid in states that expanded that program under the ACA. And about 3 million young adults have obtained coverage through an ACA provision allowing them to stay on their parents' employer plans until age 26.

For Obamacare critics, consequently, the enrollment numbers demand debunking. Here's a bestiary of their arguments for why the figures shouldn't be believed, and explanations of why they're off-base.

"How many have paid?" (Also known as "The statistics are full of deadbeats"): We examined this argument a few days ago. We observed that the concern is probably exaggerated and certainly premature, since many people who enrolled late in the cycle, including those in the March surge, may not have payments due for as much as six weeks after enrollment. Many haven't even received their first monthly premium bill yet. 

Figures from states that track this metric, including California and Vermont, show that 85% to 90% of enrollees have paid on time, which secures them the coverage they applied for.  

"Most of them were already insured": The argument here is that if we've just moved people from one insurance plan to another, we've just been wasting Americans' time and subjecting them to an onerous bureaucratic procedure as well.

The claim is based primarily on a survey in January from McKinsey and Co., which concluded that only 11% of exchange enrollees had been previously uninsured. A McKinsey survey a month later raised that figure to 27% -- still low, compared to expectations.

The major problem with the McKinsey survey is that doesn't say what its hawkers claim. The survey combines on-exchange enrollments and off-exchange enrollments; the latter are likely to heavily skew figures toward the previously insured because those are most likely people signing up again with their existing carriers. The goal of the exchange marketplaces, however, is to reach uninsured Americans. The McKinsey surveys don't break out on-exchange signups, but it's probably that the share of previously uninsureds in that group is higher than the combined total.

The few states that do break out their own numbers reinforce that expectation. Kentucky says that some 75% of its exchange enrollees were previously uninsured. New York says that about 60% of its exchange enrollees were previously uninsured. That number has been rising over time, raising the prospect that the March surge will include an even higher ratio of uninsured customers; Gaba, who has calculated a time series of New York enrollments based on the state's monthly news releases, calculates that of enrollees in mid-February, at least 92% had been uninsured.

"'Young invincibles' aren't signing up": This is related to the oft-mentioned threat of a "death spiral" in the insurance market -- if the enrollees are predominantly older and sicker consumers, they'll drive up premiums, which will discourage younger and healthier people from enrolling, which drives up premiums, which discourages, the young, etc., etc. 

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