With big new signup numbers coming out of the state and federal exchanges, Politico health care reporter Kyle Cheney reports on what the numbers mean. Enrolled? Selected? Covered? The semantics matter. Here’s a tip sheet about what to watch and listen for.
The Affordable Care Act enrollment numbers are like a national Rorschach test – they’re all things to all people.
Loose characterizations by allies and enemies of how many people have signed up, (more than 7 million as of April 1) have led to rampant – often verifiably incorrect – interpretations in the press. That matters. The way news reports characterize enrollment could tilt the national narrative about the health law in a tense election year.
There are subtle but significant differences between the number of people “signed up” for ACA plans and the number actually “enrolled.” And there’s an even greater difference, for the short term, between the number of enrollees and the number of people who have “coverage.”
Here’s some help in avoiding getting caught up in the enrollment spin:
Sign-ups vs. enrollment: On April 1 the Obama administration said 7 million people have signed up for health insurance in the ACA exchanges. But signing up for coverage is not the same thing as actually getting it. There’s one more pivotal step: paying the bill. Health insurers know that not everyone will. In fact, some of the country’s largest insurers have already reported 15 percent to 20 percent of their “sign-ups” haven’t paid. And if they don’t, they’ll ultimately be dropped and never get covered. It will take a while to know the final numbers but it won’t be 100 percent.
Enrollment vs. coverage: Even people who have paid their insurance bill typically have to wait before their coverage begins. Any of the more than 1 million people who signed up in an ACA exchange after March 15, for example, won’t get covered until May 1, regardless of when they sent in their first premium check. That means, no matter how many people have signed up, a large chunk will have to wait a month before their medical care is covered by insurance. That won’t be a problem for elective care but anyone who has anything urgent in the interim won’t be covered (and it won’t count toward the deductible).
Achieving the White House’s goal: The Obama administration initially set out to enroll 7 million people in the ACA exchanges by March 31. That goal came initially from a projection by the Congressional Budget Office, a nonpartisan agency tasked with estimating Obamacare’s impact on the federal budget. The White House embraced this projection as a worthy target for the health law’s first year. The CBO was talking about actual enrollment, the administration has tended to talk about “signups.”
A few months before HealthCare.gov collapsed in October, CBO revised its projection to 6 million enrollees. The White House has never embraced the new estimate formally and has tried to distance itself from the earlier one as well. Now administration officials say they simply want to see “millions” enrolled, a metric they’ve already achieved.
The CBO, incidentally, wasn’t trying to figure out how many people were needed to make the exchanges sustainable. It was looking more at what the government was going to have to spend because of the law.
Does it even matter? Whether the administration gets to 6 million or 7 million signups may have political significance, but most health experts agree it has no substantive bearing on whether the law succeeds. Under the ACA, each state runs its own insurance market, with different expectations and different prices that vary by location and the average age of the people who live there. That means the story of Obamacare may actually be 51 stories (counting Washington, D.C.) and not as easy to broadbrush as either side of the aisle might like.
