No, The Fact That People Aren’t Immediately Signing Up For Obamacare Doesn’t Mean It’s Failing


Uninsured Americans who experienced glitches while trying to sign up for Obamacare “definitely shouldn’t give up,” President Obama said in an interview with the Associated Press on Saturday, adding, “it is true that what’s happened is the website got overwhelmed by the volume. And folks are working around the clock and have been systematically reducing the wait times.”

The early days of Obamacare enrollment have been plagued by long delays and computer glitches. Approximately 8.6 million people visited since Tuesday but many were unable to successfully sign-up for coverage. The Department of Health and Human Services had taken down the website for weekend maintenance in an effort to fix the technical errors.

Still, insurers are reporting an uptick in the number of completed applications and “anticipate sign-ups will increase as technological issues in the enrollment process are corrected and consumers gain familiarity with their options.”

ThinkProgress learned that at least 90,000 people have now signed up for accounts in the 14 marketplaces fully operated by the states, though it was not immediately clear how many have fully enrolled in coverage. The federal government has not released enrollment figures for the 36 states in which it is fully or partially operating the exchanges.

Obama pointed to past enrollment experiences Massachusetts and argued that people tended to make multiple contacts with enrollment tools and compare products elsewhere before finally purchasing coverage:

So the best example we have is actually Massachusetts, where they have a similar program. And what happened there is that the actual sign-up rate started fairly slowly, partly because people didn’t want to pay three or four months ahead of when they would get insurance. But the interest, their ability to window shop, identify what’s going to work for them, what suits their pocketbook, what kinds of tax credits they can get — that’s already happening. And what we know is that for at least 60 percent of the people who visit that site, they’re going to be able to get good-quality health insurance for less than their cellphone or cable bill. And that is something that is — a lot of people, understandably, recognize is going to give them the kind of security they haven’t had before.

Indeed, in Massachusetts, the enrollment process was a marathon, not a sprint, despite strong bipartisan support for the law and an aggressive marketing campaign from the state and its partners (most prominently the Red Sox) encouraging the uninsured to sign-up for coverage.

Massachusetts spent approximately $7.2 million publicizing reform between Fall 2006 and May 2011, making its largest investment of $4 million in the first year of implementation. The state ran TV, radio, internet and print ads and provided grants to community organizations who helped individuals sign up for coverage. But the uninsured still took their time, reviewing the available plans an average of 18 times before committing to coverage.

In the first four months of enrollment in Commonwealth Care — the Massachusetts health care exchange for subsidized care — 15,560 of an estimated 80,000 uninsured who qualified for coverage signed up and after the first full year, one-third of the total eligible population — 122,000 people — became insured. The road to nearly universal coverage was gradual, as enrollment didn’t fully ramp up until almost a year after the initial rollout:

Commonwealth Care Enrollment

Today, the state boasts 439,000 newly insured residents and the highest rate of insurance in the country.

The Children’s Health Insurance Program (CHIP) and President George W. Bush’s Medicare Part D experienced very similar enrollment patterns. As Stan Dorn, a Senior Fellow at the Urban Institute’s Health Policy Center, told ThinkProgress, “It’s like any other human activity, it takes time to figure out how to do it right.

CHIP, a bipartisan Clinton-era initiative that primarily provides health insurance to children in families with incomes too high to qualify for Medicaid, initially fell far short of enrollment goals and more than half of the seniors who signed up for Medicare Part D didn’t do so until after the initial enrollment period and enrolled despite the Bush administration’s well-publicized initial glitches in extending coverage to low-income beneficiaries.

The Obama administration is betting that a similar pattern will work its way out with Obamacare. The Congressional Budget Office estimates that 7 million enrollees will participate in the marketplaces in 2014; 9 million will sign up for Medicaid. By 2023, the exchanges will hold 24 million people and the law’s Medicaid expansion will accompany another 13 million.

In his interview with the AP, Obama predicted that once the initial glitches are worked out, the administration will meet its first year goal and possibly even surpass it. “[W]e are confident that over the course of the six months — because it’s important to remember people have six months to sign up — that we are going to probably exceed what anybody expected in terms of the amount of interest that people have,” he said.