The Growing Puzzle Over Obamacare Enrollment

The deadline surge has signups over 6 million—but are they the right mix? 

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The Fiscal Times
March 31, 2014

Probably the only thing harder than predicting the final enrollment figures for the Affordable Care Act is guessing the winners in the NCAA Tournament Brackets. 

President Obama announced last week that more than six million people would have enrolled for insurance during the six-month enrollment period that officially ends on Monday, despite the troubled rollout of Obamacare.

Related: Obamacare Enrollment Tops Six Million As Deadline Looms

Surpassing that six-million mark brings enrollment in line with a revised estimate by the nonpartisan Congressional Budget Office – albeit well below the seven-million target that was initially set by the administration. 

Sen. Angus King, a Maine independent and defender of the president’s signature health insurance program, predicted on Sunday that the total might actually reach seven million because of a last-minute flurry of signups. 

Citing independent reporting by ACASignups.net, the enrollment figure shot up over the weekend to 6,563,000, as more than 500,000 people contacted federal call-in centers and a million people logged onto the federal website. 

"There’s no denying they're probably going to make that seven million target which was set a couple years ago,” King said on Fox News Sunday. “Two months ago, if you had asked me, I would have said there's no chance because the rollout was so bungled."

But Sen. John Barrasso of Wyoming, a member of the Senate GOP leadership, accused the administration of "cooking the books on this" and dismissing the six million figure as meaningless.

Related: New Polls Show Voters More Negative on Obamacare

Whether it ends up being six million or seven million, the signups are an encouraging sign for the White House after months of humiliating coverage of the technically flawed federal website and repeated announcement of delays in fully implementing the legislation. 

“We may not get to 7 million,” said Vice President Joe Biden. “But if we get to five or six million, that’s a hell of a start.” 

Still, the raw numbers don’t tell the whole story, and regardless of the back-and-forth bickering between King and Barrasso, there are still many unanswered questions. 

For now, at least, the administration hasn’t disclosed: 

  • What is the mix of young people – the so-called “young invincibles” to older and sicker Americans? Before the Oct. 1 launch of the exchanges, government officials had wanted upward of 40 percent of enrollments to come from young adults, to bolster the risk pool. But private analyses suggest that young people for now make up little more than a quarter of all Americans buying insurance through the Affordable Care Act.

  • How many have actually paid their first premium?  Applicants must pay their first months premiums in order to be officially enrolled in the insurance program, but some estimates suggest that as many as 20 percent haven't paid the first month's premium. 

Related: Insurers on Obamacare: Expect Premium Prices to Soar

  • How are insurers viewing the data coming in and how will that affect premiums and deductibles in the fall? There is conflicting speculation on this, in part because insurers may have differing strategies for protecting themselves against mounting medical costs and increasing their share of the insurance market.

    The Hill reported recently that health industry officials say Obamacare-related premiums will double in some parts of the country, countering claims recently made by the administration. 

  • How much has the federal website cost to date and what is the projection of costs going forward for the backend; the marketing; the advertising; the navigators; the call centers; the customer service; and all the other e-commerce service that goes with the program? Until now, the administration has provided only sketchy figures.

  • Finally, the political impact. The law is the dominant theme in GOP attacks against vulnerable Democratic incumbents in the 2014 midterm election, which will determine whether Republicans succeed in regaining control of the Senate as well as broadening their majority in the House. 

Related: Obamacare - Taxpayers in the Hole for $1.5 Trillion 

King – who is not up for reelection this year - and six Democratic senators who are facing tough reelection battles have proposed a number of improvements to Obamacare, to address widespread voter opposition or displeasure with the Affordable Care Act. 

As for the real meaning of the enrollment numbers, King said, "Those numbers are going to sort themselves out over time." Barrasso, a leading opponent of Obamacare, argued that the uncertainty over the number of young people who have enrolled and the percentage of people who have paid their premiums undercuts the credibility of the president’s health care law. 

Apart from the accuracy of the enrollment numbers, Barrasso added, "What people also want to know is, once all of this is said and done, what kind of insurance will those people actually have? Will they be able to keep the doctor that they want? How much more is it going to cost them, and we know that some of the best cancer hospitals in the country want very little to do with people who buy this insurance on the Obamacare exchanges.” 

This article was updated on April 1, 2014, to correct estimates of Obamacare enrollees who have paid their first premiums.

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Washington Editor and D.C. Bureau Chief Eric Pianin is a veteran journalist who has covered the federal government, congressional budget and tax issues, and national politics. He spent over 25 years at The Washington Post.