Americans have been through electoral math, legislative math, Supreme Court math, electoral math (again) – and then more Congressional math this last week. All of which has been in hot pursuit of the newest entrant – public exchange math. Earlier today, after considerable silence on the subject, the White House released the above chart (online here) highlighting what they believe represents the latest version of public exchange math.
The math may well be correct – but the politics are fairly evident. All of the numbers represent individual State run exchanges – and nothing from the Federally built Healthcare.gov. A more complete picture of the state run exchanges can be seen in the work of Aaron Strauss (numbers here) and fellow Forbes colleague – Dan Diamond (numbers here).
Health and Human Services (HHS) won’t commit to publicizing numbers for Healthcare.gov for another month. One important distinction is the “Accounts” column versus the “Applied/Enrolled” column. Accounts are simply those people who went through the required account creation process (which did require email and other verification). Applied are people who have shopped and submitted an application for coverage. Enrolled are people who have actually paid for coverage. For now, it’s easiest to lump Applied and Enrolled together because actually paying for coverage (being “enrolled”) isn’t required until closer to the actual coverage data (January 1, 2014).
Earlier this evening I was able to successfully create a “verified” account through Healthcare.gov for my home state of Arizona (a Federally run “marketplace”). The entire process (including email account verification) took about 10 minutes. One of the security questions correctly identified a previous city we lived in – so there was clearly an address lookup function that worked correctly. I did not use my Social Security number (which is optional). At completion, I was presented with this screen:
From here, I could have (presumably) shopped, applied and enrolled in Obamacare health coverage. Again, a sample of one isn’t anything – but I had no ”glitches” in either the account creation process – or logging back into the account after logging out. With eight weeks left to apply for coverage (effective January 1, 2014), it certainly seems possible that more of the glitches will be fixed.
In terms of numbers, they definitely aren’t that impressive (after 3 weeks), so is Obamacare a success or failure? With 8 weeks remaining (for January 1, 2014 coverage), it’s too early to make any broad proclamations either way based entirely on these numbers. There are, however, some important caveats.
1) HHS estimated that about 30% of applications would be paper based. Considering there are still tens of millions of Americans who file their annual tax returns using paper – an application for health coverage on paper is expected, reasonable and viable (even if it’s not preferred).
2) The larger story (and bigger initial success) could well be the Medicaid expansion programs. California will start on January 1 with at least 600,000 new enrollees (here).
3) The vast majority of Americans (about 200 million) will continue to see health coverage as provided by an employer, private insurance or Medicare.
4) The ACA is much larger than the technology behind Healthcare.gov. Other major provisions in the ACA include:
* The elimination of pre-existing conditions (as a basis for denying coverage)
* New Medical Loss Ratios that dictate how much insurers must spend on actual healthcare delivery (with rebates already distributed and more pending)
* Extending the age that children can stay on their parent’s plan
5) In terms of sheer size, the employer migration to private exchanges will likely eclipse the individual migration to public exchanges
6) The 9 million expected to be enrolled in the public exchange isn’t until the end of 2014 (over 17 months away)
All of which suggests that rendering a success or failure verdict at this early stage (based almost entirely on the initial and poor performance of the public exchanges) seems premature. Either way, success or failure, one thing remains certain. We’re likely to see a lot more political math between now and the end of the year.