ACA enrollment deadline

Midnight was the enrollment deadline, but people who were in process with applications can complete the process through the first two weeks of April. This is a big milestone in the law, but no matter how much everyone wants an instant assessment of the ACA as “working great” or “sucking” that answer is not forthcoming based on how many signed up. I will, however, go out on a limb and predict the answer is somewhere between “working great” and “sucking”.

Here is what I will look for over the next 6 months:

  • What happened to the rate of uninsurance? There is a RAND study that sounds like quite a comprehensive look at this question, but the details aren’t public. Coverage of the leak of the study is essentially a Rohrshach test for what you already thought. It seems likely that the uninsured rate has gone down, probably by quite a lot in historical terms, but likely not by as much as CBO projected it would in year 1. Some of this is related to explicit decisions by States, and other aspects are not. Note that the leak says the rate of uninsured for those age 18-64 fell from 20.9% last fall to 16.6% as of March 22. I would have to read the details of how the survey/study was done to really be able to say for sure what I think of it. Note that when Gallup polls, they include persons covered by Medicare, so they have uninsured as 18% in the last quarter of 2013, falling to 15.9% through February 2014.
  • Many are now realizing that there will never be a static number of people “signed up” just as there has never been a static number of people signed up for employer sponsored coverage (or the prior individual market). People get born, die, divorced, lose their job, become eligible for Medicaid, become uneligible for Medicaid, leave their job voluntarily, stop paying for coverage and so on. Monitoring rates of all these things is important, but they do not hold the breathless answer to “working great” v. “sucking” question in and of themselves.
  • Most important question is not how many young/healthy people signed up? It is, who did insurers plan to sign up and whether and how who actually signed up differs? The actual use of health care, as compared to what was assumed in setting premiums that were offered, is the key to what the premiums will be next year. And the answer to this will almost certainly differ by state, as well as by insurer within a state. We will have a sense of this when the premiums come out for year 2.

As always, the most important thing in public policy is the answer to the question: as compared to what? When people invariably ask me ‘does Obamacare suck or is it working great?’ I always ask them, as compared to what? They look at me like I have 3 heads, but I don’t know how else to even begin to provide them with an answer.

About Don Taylor
Professor of Public Policy at Duke University (with appointments in Business, Nursing, Community and Family Medicine, and the Duke Clinical Research Institute). I am one of the founding faculty of the Margolis Center for Health Policy, and currently serve as Chair of Duke's University Priorities Committee (UPC). My research focuses on improving care for persons who are dying, and I am co-PI of a CMMI award in Community Based Palliative Care. I teach both undergrads and grad students at Duke. On twitter @donaldhtaylorjr

One Response to ACA enrollment deadline

  1. OKDem says:

    On the left there has been suspicion and predictions of doom because for profit insurance companies are in the exchanges. However, this ignores that coops are included in Western and Midwestern exchanges where the coop movement has its roots.
    http://www.npr.org/blogs/health/2014/04/02/293327561/small-health-insurance-co-ops-seeing-early-success
    Before dismissing coops, remember that the Blue Crosses began on much the same model and were bought up because they were so successful.

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