Measuring Obamacare’s success: Are enough people getting coverage?

Health insurance reform was long overdue. But did it need to be done the way the architects of the Affordable Care Act did it?

Obamacare was enacted, and the private health insurance market fundamentally changed, so that we could cover millions of people who previously couldn’t get coverage.

Are enough people getting coverage who didn’t have it before to justify the sacrifices the people who were already covered — in the individual, small group, and large employer market — are making or will make?

I will suggest the country will never really be able to judge how good or how bad Obamacare is until that question is answered.

Forget the Obama administration’s spin over hitting 6 million. Forget all of the opposition spin over Obamacare’s failings.

The country’s judgment should and will come down to a simple answer to this simple question.

Of course, the more than 6 million enrollment the administration recently announced overstates Obamacare’s success because this includes enrollments that were never completed since the person never paid the premium. There are lots of reasons why a consumer might not complete the enrollment. The person may have hit the enroll button a number of times and ended up paying only once. It may have been one of the infamous “834″ transactions that never made sense and the consumer ended up having to enroll again later. Or, the person might have had second thoughts about the cost/benefit of Obamacare and decided not to move forward.

Then there were a measurable number of people who paid their first month’s premium but never paid the second month’s premium. I am told that 2% to 5% of January’s enrollments never paid in February, for example.

Whatever the reason, the real enrollment number will likely be about 20% lower than what the administration finally reports. That means the real enrollment will be closer to 5 million than 6 million.

But 6 million sounds better than 5 million.

There are two important pieces of information we need to have before the country can really answer this fundamental question about the way Obamacare accomplished health insurance reform:

  1. How many people have actually paid and completed their enrollment?
  2. To what extent have we reduced the ranks of the uninsured — how many of these people who enrolled were previously insured and how many of them were previously uninsured?

Reporters often ask these questions and the Obama administration says they don’t know. And, that’s the end of it.

But these questions are easily answered.

Every insurance company knows exactly how many people it has enrolled and who paid their premium at the end of every billing period. How else would they be able to process the claims for these people?

How many people were enrolled and paid for?

All HHS Secretary Sebelius has to do is write each of the 400 insurance companies selling in the exchanges and ask them for the total number of people enrolled and paid for on the insurance exchanges as of a certain date. She could email each of them on April 1 and ask for their hard enrollment numbers, for example, as of the end of the month of March. Either the feds or the state exchanges communicate with the carriers daily. The carriers would be able to respond in a matter of hours with the data.

Then, get a pad of paper, a pencil, and a dime store calculator and add up the numbers. By April 5th, we would know the precise answer.

Then there is the second question: Just how much have we reduced the ranks of the uninsured since Obamacare went into effect? It’s just as easy to answer this question.

We only need ask the carriers for two numbers:

  1. The number of people they insured (and were paid for) in both the individual and small group markets as of December 31, 2013 — the day before Obamacare started covering people.
  2. The number of people that were insured (and paid for) in both the individual and small group markets on a specific date — March 31, 2014, for example.

I will suggest that asking for both the small group and individual market numbers is important as people have a tendency to move between the markets, particularly as employers drop coverage and their people go, or don’t go, into the exchanges.

Then subtract one total from the other. We would have an excellent idea of just how many more people, net of any gains and losses, secured private insurance since Obamacare’s launch.

Then people could make their judgments about how well Obamacare accomplished health insurance reform free from all of the spin.

My conversations with carriers suggest that about half of the enrollments come from the ranks of the previously insured. But that is just anecdotal information. I don’t have a hard number. And, why should anyone believe me particularly when the real answer so easy to get?

Yes, there might be some movement between the large employer market and these other markets and there are a very few carriers not participating in the exchanges. But, I will suggest, to the 90th percentile, we’d have our answer. It would sure be a lot more accurate answer than someone doing a poll involving a few hundred or even a few thousand people.

Why should the administration make the effort to get this information? They know the answer wouldn’t spin as well as saying they have enrolled 6 million people and arguing that millions of previously uninsured people have coverage.

But the fundamental question is: Did we sign-up enough people to really reduce the ranks of the uninsured and therefore make this new health law worth it?

The information the country needs to answer that question, and to really judge Obamacare for themselves, is remarkably easy to produce.

And, the press needs to do its job making sure the people get it.

Robert Laszewski is president, Health Policy and Strategy Associates and blogs at Health Care Policy and Marketplace Review.

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  • NewMexicoRam

    My understanding is there were between 30-40 million uninsured before last fall.
    Just over 7 million have signed up, but if you subtract those who were cut off of their insurance and those who were eligible for Medicaid anyways, you are left with less than 3 million who are new sign-ups.
    How can anyone justify all the money and effort that has been spent to get under 3 million on insurance? No one can, unless you are wearing blue glasses.
    What a fiasco! This could have been done a lot cleaner and with better efficiency. Now we are left with a mess.
    They were right–they had to pass the bill before they knew what was in it.

  • ninguem

    Most of the obamacare signups that weren’t already insured, are Medicaid.

    Now, signing up more Medicaid recipients is fine as far as it goes.

    It may be a problem with accelerating the “death spiral” some think about.

    Bur more to the point, IMHO is, if all you accomplish is to expand Medicaid, then just expand Medicaid.

    The matrix was already in place. Fund Medicaid as much as you want, to sign up as many as you want.

    We did not have to pervert the entire USA healthcare system, just to sign up more Medicaid.

  • Margalit Gur-Arie

    Yeah, well, that’s one question, but I don’t think this is THE question. The question in my mind is how many Americans are able to obtain proper care today, as compared to before the ACA? And please feel free to include projections for a few years down the road, if this is “just a first step” and I’m expecting too much.
    Oh, and by “proper”, I mean care provided by highly trained physicians, in state of the art facilities, and individually customized to accomplish the best possible outcomes for each person. Basically, the kind of care we provide, at our expense, for our leaders in DC.

  • Margalit Gur-Arie

    It’s not “this” President. It’s all Presidents since Mr. Reagan, and including Mr. Clinton’s second term, with spectacular assistance from the Supreme Court and an inept and mercenary Congress.

  • Patient Kit

    In related wonderings, I wonder how smoothly the first six months of enrolling people in Medicare and Medicaid went in 1966. The creation of Medicare and Medicaid were probably the last changes to our healthcare system as big as the ACA, right? Were those programs instant smooth sailing successes? Or did they need time to work out the problems? I know it took 4 decades to add Part D to Medicare, before which doctors’ parking lots were routinely littered with Rxs seniors had tossed because they couldn’t afford to fill them. (Not that I’m advocating giving the government four decades to try to work out the kinks of the ACA.)

  • B Viner

    Where do you get these numbers and are they believable?

  • John C. Key MD

    Not sure your numbers are right, but I am glad to know that I am not the only one whose comments get deleted. Such is life when the controllers do not tolerate dissent.

  • Patient Kit

    I think it will be much easier, going forward, to amend and revise the ACA than it was to pass it in the first place and than it would be to repeal it. I’m trying to be hopeful that the problems can be worked out. I do know that prior to January 1, 2014, I was newly uninsured for the first time in my life at the same time that I was newly diagnosed with ovarian cancer. That dx instantly became a pre-existing condition that no insurance co would cover me for. That is my reality. I would have much preferred a single payer system to the ACA. But the ACA gives me more hope than our system did pre-ACA.

  • Lisa

    One point – not all people with pre existing conditions use consume resources. I have several pre-existing conditions, including a cancer diagnosis, that have precluded me from buying insurance pre ACA. I am actually pretty healthy at this point. I am not using a lot of health care resources. Other people have pre-existing conditions that are pretty minor. One of my friends could only get insurance through a state high risk pool (very expensive insurance) due to a stable psychiatric illness. She takes a cheap antidepressant and functions well. She doesn’t use a lot of medical resources. I know many people in similar situations.

    I will also point out that many people bought high deductible insurance pre ACA because that was all they could afford. At least now, the out of pocket max is lower.

    But yes, I agree this law benefits insurance companies more than patients, but any law in this country will benefit insurance and corp med unless the politics change.

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