Up Next: The Obamacare Enrollment-Number Spin War

Get ready for low numbers in private insurance, a huge success on the Medicaid-enrollment front—and a massive debate over what it all means.
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Lucy Nicholson/Reuters

The expectation-setting game was in full swing Tuesday morning as anticipation built for the release of the first government report on Affordable Care Act enrollment. The numbers are expected to be announced mid-week, perhaps as early as Tuesday.

Two reports on Monday suggested the first month of enrollment in private health plans under the ACA might be, at best, only about 20 percent of what was hoped for.

Between 40,000 and 50,000 people have signed up for insurance through Healthcare.gov in the 36 states that didn't build their own sites, according to the Wall Street Journal, and about 50,000 have signed up through 12 of the state exchanges, according to a survey by Avalere Health, a health-care consulting company. The Obama Administration initially expected first-month enrollment to be about 500,000, but major problems with the federal website have left it unusable for much of the past six weeks.

Meanwhile, enrollment of the poor and near poor under the ACA's Medicaid expansion bounded ahead in the first month, even though only half of the states have accepted federal funds for moving citizens who earn up to 133 percent of poverty-level income into the federal insurance system for the poor. Medicaid has enrolled 444,000 people in 10 states through the ACA, according to Avalere. Since that figure represents fewer than half of the 25 states that will report numbers through the government, the official number will certainly be higher.

These numbers are sure to be the subject of controversy in the days ahead, as opponents and supporters of the overhaul alternately crow about its early failure to meet expectations and plead that people not rush to judgment.

By Tuesday morning, both sides had taken up their by-now well-worn political positions in advance of the release of official numbers. "It’s time for of Obamacare! " Senator Ted Cruz tweeted. "Enrollments Stall, Cancellations Soar," the RNC trumpeted in a release Tuesday morning, signaling the GOP's intention to contrast the small number of new enrollees in private insurance with the large number in the existing private-insurance market who are seeing their old plans canceled. The RNC also released more web videos mocking the Obamacare rollout.

On the other side, the defense consists mainly of pointing to the 2007 Massachusetts experience, when private-insurance enrollment started slowly and then bunched near the enrollment deadline. "Obamacare's October numbers are going to be low: The real deal is still to come," argued The New Republic's Jonathan Cohn.

A sure subject of controversy to come: how the government decides to count someone as enrolled in a private plan. Wonkblog's Sarah Kliff reported the administration plans to include everyone who has gotten to the final step of the online application process—"because that's where their interaction with the Healthcare.gov site ends"—even if they have not yet sent a check to insurers to pay for the start of coverage in January. 

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Garance Franke-Ruta is a former senior editor covering national politics at The Atlantic.

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