On Tuesday, the Obama administration announced that more than 7.1 million Americans had signed up for private health plans through the Affordable Care Act’s marketplaces as of the March 31 enrollment deadline, surpassing the Congressional Budget Office’s (CBO) original projection despite HealthCare.gov’s disastrous launch. But Obamacare’s critics weren’t exactly impressed.
Many prominent conservatives responded to the announcement by pouncing on the fact that it’s still not clear how many people selecting plans have paid their first month’s premium — the final step to actually securing health coverage. “We don’t know of course, exactly what they have signed up for, we don’t know how many have paid,” said Senate Minority Leader Mitch McConnell (R-KY) in a statement.”[C]learly we still don’t have information on how many of those individuals have paid their premiums,” added Rep. Tom Price (R-GA) on a conference call with reporters.
Others pointed out that the health law has also canceled millions of policies, so many of the people enrolling in the new marketplaces are simply being forced to buy a different plan under the ACA. “The bulk of the people who are signing up had insurance to begin with, and they probably had their insurance canceled because of Obamacare… It is abundantly clear this thing isn’t working,” said Sen. Ted Cruz (R-TX) during a Tuesday appearance on Fox and Friends. Republican National Committee Chairman Reince Priebus, GOP Virginia Senate Candidate Ed Gillespie, Rep. Paul Broun (R-MD), and Sen. John Cornyn (R-TX) all expressed this sentiment.
And conservative health care columnists at the National Review and Forbes issued similar rebuttals to the enrollment figures, arguing that about 20 percent of the 7.1 million signups haven’t (or won’t) pay a premium, and that just a third of enrollees were previously uninsured. That would mean that Obamacare’s marketplaces have newly insured just about two million people.
But there are several holes in this analysis. For one thing, all of these critics are assuming the low end of premium payments (80 percent) when in reality, industry officials and Obama administration officials have pegged payment rates at somewhere between 80 and 90 percent — it varies from market to market — and several states have been putting the number at around 85 percent.
Chances are that those numbers will only continue rising. Charles Gaba, who has been meticulously tracking Affordable Care Act enrollment data at ACASignups.net, points out that a substantial number of people who have yet to pay a premium may have entirely legitimate reasons for it. For instance, the insurance company may have trouble processing payments or the payment may not actually be due yet. Just under 48 percent of policies purchased during the 2014 enrollment period either just came into effect this week or haven’t yet been activated at all. Policies purchased since mid-March won’t take effect until May — meaning that about 2.2 million Obamacare plan premiums (or 30 percent of all signups) aren’t even due until the end of April.
Similarly, implying that most of the new enrollees already had insurance, and are simply being forced into new plans under the ACA, ignores some crucial nuance about the available data on the previously uninsured. According to a new survey from the RAND Corporation, about a third of private marketplace enrollees were previously uninsured and the share of uninsured Americans signing up increased substantially in March. (That survey’s full results and methodology won’t be available until Friday.) Many uninsured Americans likely waited until the last minute to purchase coverage.
It’s also dishonest to completely dismiss the stories of millions of previously insured Americans who are buying new ACA-compliant plans, since this is also a coverage expansion in many cases. Obamacare plans have higher benefit standards and offer more robust financial protections than individual policies in the pre-ACA market, which were often so skimpy as to offer little financial protection for Americans who got sick. That was a system wherein three-quarters of all medical bankruptcies happened to people who had health insurance but were “underinsured” — i.e., the coverage they had failed to protect them from unaffordable out-of-pocket costs or applied caps on care. A recent study by the Commonwealth Fund found that 32 million Americans were underinsured in 2012, and that at least 11 million of them could see their costs reduced or their benefits grow under Obamacare.
The total number of people gaining coverage through the ACA is also substantially higher once you consider Obamacare’s other provisions. For instance, the RAND survey found that at least 9.5 million Americans have newly gained insurance either through the private marketplaces, the Medicaid expansion, or the rule allowing young Americans to stay on their parents’ insurance plans until age 26. Charles Gaba projects that those numbers could be even higher, with somewhere between 14.6 million and 22.1 million people covered under Obamacare, even when accounting for the estimated 3.7 million insufficient policies that were canceled under the ACA.
There are still many things we don’t know about Obamacare’s first enrollment season. The final enrollment count, the age mix of the risk pools, and the degree to which ACA premiums will rise next year won’t be evident for at least several months. And signups will actually continue, since Americans who were “stuck in line” for Obamacare in recent days have at least another two weeks to finish their applications. But conservatives attempting to spin Obamacare’s enrollment milestone aren’t exactly being forthright about the available data.