ObamaCare: enrolled, unpaid, invalid
The official figure for ObamaCare enrollment is up to 360,000, which is about a third of what it was supposed to accomplish by now, but good enough for the Department of Health and Human Services to stop including Medicaid applicants in the number. It’s still kind of amazing they ever got away with that – a timeless example of media bias and the incredible lack of fact-checking curiosity reporters display toward claims from politicians they like.
“We’re got 30 percent as many enrollments as we were supposed to!” qualifies as inspiration in this New Normal of low standards and reduced expectations. An impartial media would treat this claim as laughably out of touch, even callous, by measuring it against the over five million people who lost insurance because of ObamaCare. Let me put it this way: imagine we’re dealing with some Republican privatization plan that caused 5 million people to lose statist benefits, but counted 350,000 enrollments in private plans, compared to the five or six hundred thousand they anticipated. Think anybody in the media would allow a single Republican, anywhere, to describe it as even a qualified modest success? Or would those Republicans be portrayed as heartless political hacks who don’t care about the people who are hurting because of a misbegotten policy?
That 350k figure has to be treated as highly dubious, too, considering the Administration’s penchant for treating everyone who ever clicked a button on Healthcare.gov as an “enrollee.” I’ve said it before: there’s only one metric that really matters, and that’s the number of fully processed, purchased insurance plans, with the first premium paid. That’s not a matter of opinion or political criticism – it’s the law. And it’s going to be the only thing that matters to every genuine Affordable Care Act enrollee who heads to the clinic or hospital for treatment next year.
HHS Secretary Kathleen Sebelius was specifically asked about this during House Energy and Commerce hearings today, and she confirmed – if any confirmation were really needed – that “you have to be enrolled by the 23rd and make a payment by the end of the year in order to be fully insured.”
And yet, that’s the one metric the Administration outrageously insists on keeping hidden, even though it’s patently obvious they have the number. No business operation in the Western world is incapable of telling you how many payments it has processed, even the government-managed debacle of ObamaCare. If nothing else, even if the lousy half-billion-dollar ObamaCare computer system can’t spit out an accurate report, it would be the work of days at most to have insurance providers total up their payment systems and forward them to Washington for tallying. They could do it in a week even if they had to use snail mail, which they don’t.
But there are disturbing implications that this super-secret number of paid purchases is not looking good. Forget about whatever Kathleen Sebelius is going on about in Congress, including her hilarious call for “investigations” (by which she means the usual bucket of Administration whitewash) into how she and Barack Obama could possibly have blown the Healthcare.gov launch. The news of the day is from Charles Ornstein, a senior ProPublica reporter, in a blog post entitled “The key ObamaCare deadline few are talking about.”
“There is also a lot of worrying going on over people making payments,” industry consultant Robert Laszewski wrote in an email. “One client reports only 15% have paid so far. It is still too early to know for sure what this means but we should expect some enrollment slippage come the payment due date.”
Another consultant Kip Piper, agreed. “So far I’m hearing from health plans that around 5% and 10% of consumers who have made it through the data transfer gauntlet have paid first month’s premium and therefore truly enrolled,” he wrote me.
“It naturally varies by insurer and will hopefully increase as we get close to end of December and documents flow in the mail,” added Piper, a former official at the Centers for Medicare and Medicaid Services. “But overall I’m hearing it’s a small portion so far. And that, of course, is a fraction of an already comparatively small number of people who have made it through setting up an account, getting verified, subsidy eligibility determined, plan selected, complete and correct data transferred to the insurer, and insurer set out the confirmation with invoice for consumer’s share of the first month’s premium.”
Five to ten percent? Even allowing for a rush of late-arriving payments, frantically processed in the mere eight business days between the cutoff date and the first day of 2014, that’s horrifying. Is it likely that number will so much as double or triple in the handful of days remaining? Even the higher 15 percent figure Bob Laszewski heard from some of his sources would be crisis-level. All hell is going to break loose in January, because different state regulations and provider policies come into effect for different people. Some of them can’t just fire off a check in January and get their coverage freshened up.
Some of the providers quoted by Ornstein think part of the reason for the low payment percentage is that customers don’t understand that their first payment must be processed for their coverage to become valid. That seems like something that wouldn’t have been difficult to explain to buyers… assuming they didn’t get kicked out of the bug-riddled Healthcare.gov system before they saw the “What to do next” messages. Consider it one more reason you don’t launch a crappy online system with half the code missing, especially when people are legally required to use it.
It would also seem imperative for Health and Human Services to have sounded alarm bells a long time ago, and issue emergency stop-the-presses announcements reminding customers to make their crucial first premium payments. But they didn’t, because that would have been politically disastrous. They still won’t, because many customers would then discover the half-completed system can’t process their payments in time. They’ve already begun quietly asking for fewer paper applications, because they can’t handle the load. They won’t be any better able to deal with a truckload of paper checks.
My guess is that the Administration will tell whatever crazy stories, and deploy whatever distractions, to get through the last couple of news cycles before year-end, then deal with whatever happens in January. It’ll be tough on the people ground beneath the steamroller of spin, but we’ve already established that the Administration views them as “anecdotes” whose suffering is a small price to pay for “progress.”
Update: As to the “death spiral” question about whether the paltry handful of people paying for these policies includes a sufficient number of healthy young suckers willing to pay sky-high premiums to fund everyone else’s benefits, the Daily Caller says that metric isn’t looking good, either:
Too few young people are joining the plans offered by companies using the Obamacare website, said Robert Laszewski, a plugged-in insurance consultant.
Older clients, aged above 40, comprise 60 percent of the new Obamacare customers at one of his client health-care companies, Laszewski told The Daily Caller.
The skew is “very, very bad,” said Laszewski, who is president of Health Policy and Strategy Associates, Inc.
Of course, the Administration says we shouldn’t worry our pretty little heads about all these big, scary, confusing numbers. In fact, they’ve been saying all those original projections of 7 million enrolled by April should be viewed as loose theoretical constructs, not “promises” or “goals” per se. Basically, you’re supposed to trust them and assume everything is going swell, until someone in scrubs tells you otherwise.
But on the topic of those original promises, remember the most infamous one: that nobody would lose their health insurance, period. That means the original projection was for 7 million new covered individuals by April, with zero people bounced out of coverage, making ObamaCare about 12 million insurance policies behind schedule at the moment.