With the Republican Party done distracting America with its what-was-that-about shutdown, attention has turned to the spectacularly terrible rollout of the Obamacare online marketplace. The best way to get a sense for how poorly its going — besides that President Obama is giving a big speech on Monday to assuage concerns — is by looking at the numbers.
Some context. One of the most important components of the Affordable Care Act (a.k.a Obamacare) was the creation of exchanges on which insurance companies could provide coverage plans to individuals without any insurance. Given that Obamacare mandates everyone be covered, the exchanges were created to 1) give people access to affordable plans and 2) drive down costs by enrolling more young, healthy people — the sorts of customers that are typically less likely to get health insurance, and who are less likely to lead to losses for insurers.
As we've noted, the Healthcare.gov website was built to provide people easy access to enrollment in states that didn't establish their own exchanges — generally states with Republican governors that are unexcited about Obamacare. States with their own exchanges generally have their own websites, but still rely on a connection to the federal government's databases in order to verify enrollment information. Failures in those connections, both at Healthcare.gov and the state exchanges, are one of the main reasons that enrollment numbers are far, far lower than expected.
Right now, exchanges are perfectly designed to attract the sickest people and repel the healthiest. Exactly the opposite of what's needed.— Ryan Lizza (@RyanLizza) October 19, 2013
So let's look at the numbers.
According to the Associated Press last week, there have been 476,000 successful applications for coverage under an Obamacare exchange. But that figure, as The Washington Post noted, only includes applications that have been completed, the first step in a three-step process. The second step is eligibility verification — in which the application is compared to the government's databases to validate the amount of subsidy an applicant can receive. There have been an unknown number of completed applications, a figure that the government claimed earlier this month that it didn't have access to.
Remember, though, that there are 17 states that run their own exchanges. (That's one reason that the government might be able to argue it can't say with certainty how many people have enrolled.) The states that are running their own exchanges have been more forthcoming with their numbers. According to the most recent numbers we could find, here's how they're faring.
Online registrations: 94,500. Insurance enrollments: Unknown. (source)
Online registrations: 1,450. Insurance enrollments: 226. (source)
Online registrations: more than 10,000. Insurance enrollments: 3,847. (source)
Online registrations: 500. Insurance enrollments: Unknown. (source)
Online registrations: 34,000. Insurance enrollments: 11,000. (source)
Insurance enrollments: 1,121. (source)
Online registrations: 12,000. Insurance enrollments: 5,569. (source)
Insurance enrollments: 3,795. (source)
- New York
Online registrations: 134,000. Insurance enrollments: Zero. (source)
- Rhode Island
Online registrations: 1,701. Insurance enrollments: Unknown. (source)
Online registrations: 5,200. Insurance enrollments: Unknown. (source)
Online registrations: 66,776. Insurance enrollments: 24,949. (source)
Adding up those figures gives us fewer than 50,000 confirmed enrollments. It is safe to assume, though, that Obama will present a larger number during his speech on Monday. But given that millions of people are uninsured in the United States (Deseret News has a good per-state breakdown), this is hardly an impressive number.
This is only part of the picture. Another component of the health care reforms is the expansion of Medicaid to more low income people. As we noted earlier this month, that process, too, has been inhibited by Republican governors. In states where the expansion has gone forward, like California, enrollments are moving much more rapidly, perhaps in part because the Medicaid system has an existing, tested infrastructure. In California, 600,000 people have been added to Medicaid under the Affordable Care Act's provisions.
But that won't help keep health care costs down. For that, people need to enroll on the Healthcare.gov site. And, as we reported on Sunday, it's relying on a heavy technological push to accomplish that. The existing website relies on 500 millions lines of code, an estimated 5 million will need to be rewritten. The site could take several weeks to fix — and possibly not be in completely working order until after the December 15 deadline for coverage by January 1. Some consolation: the individual mandate only requires you be covered for nine months of any year.
The federal government, however, would be well-advised not to wait one additional second in getting the system running at full capacity, unless it wants to see 51 Republican senators in 2015.
Photo: Patrick Lamanske works with Amanda Ziemnisky, right, of the Champaign Urbana Public Health District office in Champaign to try to sign his wife, Ping Lamanske, left, up for health care coverage through the Affordable Care Act. (AP)