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The Administration Probably Won't Reach Its First Enrollment Goals


More data on ACA enrollment figures is slowly trickling out, and, despite some initial promise, things are not now looking great for the Obama administration’s enrollment goals. WaPo has a neat graphic looking at how the numbers broke down for the first week of traffic on the federal exchange site. While more than nine million people visited, only 3.72 million even tried to register, and of those only 36,000 eventually completed enrollment. That comes out, according to Kantar US Insights, to a rate of 99.6 percent of people who visited the site not coming away with any insurance. When you add to that the fact that visits to the site have already dropped 88 percent, you see the problem the administration is facing, with only a couple of months to go before the individual mandate kicks in.

ACA supporters are starting to admit to themselves that this is a problem. Matthew Yglesias over at Slate has a post up about how the administration might end up being far off the enrollment goal it set itself for October:

Today we learn from the Associated Press that the Department of Health and Human Services was targeting 500,000 signups by the end of October which seems—shall we say—unlikely at this point. […]

This is the kind of thing that if it gets fixed in time, nobody will care about in 10 or 5 or even 1 year. But there really is a problem if it doesn’t get fixed in time. Insurance risk pools need scale to really work, and to be viable you need to make sure you sign up plenty of youngish people who don’t have acute health care needs. That was always going to be a difficult lift, but it’s one the administration was very much prepared for. These technical problems, however, are throwing them off their game plan and if they persist too long will make it hard to make the numbers the program needs to succeed.

One question that remains is whether the individual mandate penalty will bring visitors flooding back to an improved site in mid-December/early January. After all, even though visits have already dropped 88 percent, the ACA isn’t just like a normal novelty product that will stabilize at low but persistent traffic levels when the newness rubs off. Traffic will probably come in spurts as various parts of the law go into effect, and the January 1 deadline is among the most important of those parts. But just how consequential that mid-December, pre-deadline traffic spurt will be depends on how easy subsidies are to get and how painful penalties are to face; neither is looking particularly favorable for the law’s prospects at the moment. Time will tell.

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  • Boritz

    There is the prospect for a redux of the roll-out but next time with a looming deadline hanging over everyone’s head. Will there be waivers for the individual mandate after all if the technology continues to fail? The Republicans asked for a delay in the individual mandate and they will appear vindicated unless this starts to go much more smoothly. What a moral argument couldn’t budge the technology might.

  • Stacy Garvey

    It’s not going to work even if the technical aspects are fixed and fixed quickly. The actual plans and premiums are awful. They’re expensive with limited benefits. The deductibles and out of pocket maximums are high. The premiums even for the young are expensive. They’re not going to get enough enrollment in the young and healthy category to compensate for the older sick demographic. Young people whose parents have group insurance can stay on their plans until 26 – this limits the number of young willing to enroll in Obamacare. The penalty tax is 1% of earnings or $95. For those earning, say, 30K their tax would be $300 – not enough of a penalty when weighted against an annual premium of $2,400 with a deductible of $12,000.
    My guess, young people earning higher salaries will have access to group insurance through either their parents or employers plans. Moderate earning young people won’t sign-up because they won’t have access to the subsidies, the cost will be prohibitive, and the benefits limited. The low earning young won’t sign-up unless they qualify for Medicaid. Most who fall into that category live paycheck to paycheck, and, unless its free, won’t be able to spare the money.
    It’s doomed.

  • rheddles

    How soon will they start advertising the penalty to get young’uns to sign up? Or will they use patriotism?

    • Andrew Allison

      You mean that $95 to avoid $2,000-$3,000? Give me a moment to think about that LOL

  • Steppahouse

    The most important question, then, revolves around assuming that they don’t get the 7 million minimum needed to cover the law’s costs. What moves can the Administration make on its own in that event? This is the one thing I’m not seeing anyone talk about. If I were cynical, I would think that’s because even pro-Obama supporters have decided that the White House is too unpredictable and arbitrary to go out on a limb guessing what they might do if the ACA numbers simply never materialize.

  • Darling Lily

    If they need young people, why did they insist on allowing “children” to stay on their parents’ coverage til they were 26??

    Hard to believe this hasn’t been engineered to bankrupt insurance companies and drive us all the single-payer. Which is failing everywhere else in the world. ( Does anyone know any Europeans or Australians who don’t carry their own private insurance because the state run plan is so ghastly?)

    • Andrew Allison

      Another single-payer knee-jerk. If you actually knew anything about the subject, you would know that only about 10% of those covered by single-payer plans (which, incidentally, provided better outcomes than the ridiculously costly US system) choose private insurance.

      • Darling Lily

        Having grown up in the UK, where everyone we knew carried private, I have to say that I find your 10% figure rather sketchy. The only ones who didn’t carry private were people totally dependent on government.

        And in Australia, it is now mandatory to carry private insurance. This in a country that has only had universal care for 30 years, and has a population less than the state of CA.

        Who pray tell will be able to afford higher premiums with less benefits?

        • Andrew Allison

          I too grew up in the UK, and knew NOBODY who had private insurance.

          According to Wikipedia “Private health care has continued
          parallel to the NHS, paid for largely by private insurance, but it is
          used by less than 8% of the population, and generally as a top-up to NHS services.”

          As to who will pay higher premiums with less benefits: far, far fewer than promised.

          • Rich K

            So whats your point here?

          • Andrew Allison

            That the people who inveigh against single-payer health insurance don’t know what they’re talking about.

          • Darling Lily

            We clearly ran in different circles.

            Regardless of one’s opinion and manipulated statistics, the fact remains, “free” healthcare provided to an entire population is wholly unsustainable.


          • Andrew Allison

            The statistics are not manipulated. They simply report measured results, among which are the evidence that, contrary to your assertions, not only are single-payer systems not failing, but they provide better outcomes than the US does and the vast majority of those covered by them don’t feel the need for private insurance.

            Incidentally, WRT The Independent article, if the NHS were to introduce a co-payment, it would still be a single-payer system (one payer for the entire population).

          • Darling Lily

            Dear heart, all statistics are manipulated. I do it for a living. ( I should say, did it! ) Many of the “outcomes” in the UK/EU do not include the same stats and other inputs going in as are included in similar scenarios from the US.

            My point is that it is unsustainable, period. It will start off as a co-pay, then the co-pays will increase, then you will be expected, as in Australia, to carry your own private insurance in addition to the “free” government run. At what point is it then single payer?

            And I must say I am enjoying our debate; we’re keeping it civil! Thank you.

          • Andrew Allison

            You are misinformed.
            “The Australian Government provides a basic universal health insurance, Medicare. Private health insurance in Australia is limited to those services not covered by Medicare or to services provided in private hospitals.
            The Australian Taxation system encourages [i.e., does not require] middle to high income earners to take out Private Health Insurance. While most taxpayers pay a 1.5% Medicare levy, an additional 1% Medicare Levy Surcharge is payable by those taxpayers who earn more than $76,000 and do not have Private Health Insurance.” (

      • BrianFrankie

        Another single payer system apologist heard from. If you actually knew anything on the subject, you would recognise the NHS for the death trap it is. The Grim Reaper is a piker compared to the NHS. In fact, I think the Liverpool Care Pathway may well have been created by the GR, just to make his job a bit easier.

        US hospitals have the best performance in the world. Many other first world countries, including Australia, where I live, are comparable. The UK is not, as I can attest from personal experience living in the UK. As should only be expected when the staff of the NHS spends time murdering patients rather than trying to help them.

        • Andrew Allison

          Utter nonsense, like all the other knee-jerk comments about single payer. The fact that the US medical system provides worse outcomes at far high cost than the single-payer systems in all other developed nations is well-establish by factual studies. Look up studies of of the number of deaths in US hospitals resulting from errors and unnecessary procures. The fact that 90% of the population of the UK elects not to have private insurance is all the evidence needed as to the overall efficacy of and satisfaction with the NHS.
          I think if you dig a little deeper, you will find that the Australian single-payer system outperforms the US on every measure, at much lower cost.

          • BrianFrankie

            Andrew says:
            >> Utter nonsense, like all the other knee-jerk comments about single payer. The fact that the US medical system provides worse outcomes at far high cost than the single-payer systems in all other developed nations is well-establish by factual studies. <<

            And there you have it – the perfect example of Ronald Regan’s observation:

            "The trouble with our Liberal friends is not that they're ignorant; it's just that they know so much that isn't so."

            Factual studies have demonstrated far better outcomes of the US medical system than the UK system, at far higher cost. There is little dispute in academic circles on this point. The issue with the US system is cost, not quality.

            Liberals typically seize on discrete data points – often infant mortality or life expectancy, as Andrew does in his post. Such facile observations should be a warning to any thinking person. To take whole-population health metrics and equate them to the quality of the health care services is the very definition of reductio ad absurdum, and entirely unacceptable as demonstrators of health system outcomes.

            The truth is that comparisons between health systems are difficult – one must grant that. However, when rigorous studies have attempted to eliminate confounding factors and compare like populations and treatment regimens, the US system comes out at least equal to, and typically better than, single payer systems. Here is one example:


            And out of first world single payer systems, the NHS is by far the worst. Sir Jarman’s study, revealing 45% increased death rates in the NHS, is but one example. There are better SP systems. Australia, where I live, is generally regarded quite highly, but even here, the parallel private system has higher quality and better outcomes.

            Beware those who substitute ideology for reason.

          • Andrew Allison

            What utter rubbish. To dispose of the irrelevant ideological BS first, I’m a data analyst first and a Libertarian second. As to the rest of this nonsense, note the absence of any links to the so-called “factual studies”. The only meaningful metrics for the quality of heath care are infant mortality and longevity. For the utterly sordid details of just how inadequate and cost-ineffective the US system is, see:

          • BrianFrankie

            >> As to the rest of this nonsense, note the absence of any links to the so-called “factual studies”. <<

            Right. Of course. The absence. Other than the presence of, well, you know, what's the word? Oh, yes … the link.


            But I guess you don't need to actually read what is posted, since you already think you know the answers.

          • Andrew Allison

            Oh, I see. A paper which purports to explain away the superiority of Canadian healthcare on the basis of American drug and alcohol abuse explains why, as I wrote, “. . . the US medical system provides worse outcomes at far high
            cost than the single-payer systems in ALL other developed nations . . .”, a statement backed up by the links which I provided but you apparently couldn’t bring yourself to read.
            The whys and wherefores of this sorry state of affairs are debatable, the facts are not.

  • Rich K

    So I’m a 20 or 30 something who is going to be scared to death of losing a whopping $95 dollars from my tax refund if I don’t shell out a few hundred a month at minimum for a HC policy? Easiest decision they will make all year.( and no, they won’t earn enough to be subject to the 1% rate either so don’t bother to toss that dead fish in my pan)

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