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ACA Agonistes
Seven Million Get Obamacare, But How Many Will Pay?

Obamacare has beat its revised goal of enrolling six million people on the federal exchange, with new signups coming it at 7.1 million by the end of March. But all may not be as it seems. One point we’ve emphasized about this enrollment number is that it doesn’t tell us how many of those signing up were previously uninsured. The law was supposed to expand access to the previously uninsured, not kick people off their current plans and on to the exchanges. And there’s another way this announcement could be misleading. We don’t know how many of those seven million will pay their premiums. If Americans sign up now only to miss payments later, the initial enrollment figures will wind up telling us little about how successful Obamacare has been.

How many will pay their premiums? Megan McArdle makes a fascinating point. Because forty percent of total signups came later, McArdle argues that many of these signups were from one of three groups:

1. People who are incredibly disorganized.

2. People who are so financially pinched that it was important to wait until the last minute so that they could pay eight months’ worth of premiums instead of 12.

3. People who are young and healthy enough to make acquiring insurance less than urgent.

If this is true, then the last-minute surge will be both good and bad news for Obamacare. It’s good news because young procrastinators could shift the demographics of the exchange risk pools. The younger the pool, the better the exchanges will work. It’s bad news, on the other hand, because the “financially pinched” would be less likely to pay their premiums. Only time will show how all these factors shake out, but it’s clear that there’s much more ambiguity built into the enrollment number than Obamacare’s cheerleaders are willing to admit.

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  • Boritz

    These issues will determine two things: how much money the law needs from the treasury to prop it up and how much misinformation the media and government supporters need to espouse to prop it up. If you care about those things then this is an important matter.

  • DiogenesDespairs

    Media to public: Look, a unicorn!

  • S.C. Schwarz

    Does anyone believe anything these people say anymore? In a few months we will quietly read that it wasn’t really 7.1 million but more like 6 million. Then a few months later we will learn that of those 6 million only 5 milion ever really paid a premium. And then we will learn that of the 5 million 3 million were just replacing policies that they were kicked off of because of Obamacare. But by then the elections will be over so who cares?

    We were told there were 30 million uninsured and all this was necessary to solve that problem. What happened to the 30 million?

    • Corlyss

      Raise your hands, all of you who thought an administration that repeatedly lies about unemployment stats would NOT lie about figures that it claimed repeatedly it couldn’t ascertain. Dems: The home of “Let’s declare victory regardless and go home.” Dear hearts, the speeches have been written since March 2010.

  • Anthony

    “The Affordable Care Act has unleashed a great many changes – some good, some bad, some in between. And its going to be a long time before there’s enough evidence to assess them carefully.”

    “Whatever the final tally, you can count on law’s critics to keep saying the number is less impressive than it seems. They will say some people aren’t paying premiums, while others had insurance already. They will say sign-up numbers don’t count for the law’s downsides – like how many people lost plans they liked, or are paying more for coverage than they did before, or are having difficulty seeing the doctors they know. All of these arguments have at least some truth. And you should think about them when, inevitably, the administration celebrates the final enrollment statistics.” Additional perspective to McArdle’s Bloomberg article.

    • Andrew Allison

      With respect, the real story about ACA is very simple: how many formerly uninsured were insured and at what cost.

      • Anthony

        Sometimes the best strategy is to say nothing and reference the quote.

  • Andrew Allison

    The point which you continue to fail to acknowledge is that this “enrollment” number is NOT an enrollment number: enrollment requires paying a premium, and estimates are that about 20% of those signing up before the recent surge have not done so. Common sense suggests that the number will be even higher for the last-minute sign-ups, who now have three months to decide whether to actually pay a premium. The real criterion is how many of those who actually enroll were not previously insured, and what it cost to enroll them. I suspect that the truth is that it would have been cheaper to just give them Medicaid.


    Blah, blah, blah. Tens of millions have received free medical services like vaccinations and screenings through Obamacare. Millions of others have been enrolled in Medicaid or allowed to stay on their parents. Millions more have access to insurance they could never have qualified for because of a pre-existing condition or won’t be kicked off because they get sick. Millions of others are savings hundreds or even thousands due to the subsidies available through Obamacare. Conservatives turned a CBO estimate of initial enrollees into an ironclad goal that HHS needed to reach to maintain credibility, assuming that Obamacare could never have seven million people sign up in time. Now that this threshold has been reached, we get bitter commentators trying to move the goalposts. Yes, some people won’t follow through and young people may lag behind. But one thing that has stood out clearly over the last six months is the pressing need for access to affordable health insurance, a goal now in reach for millions for whom it was previously unobtainable.

    Is Obamacare perfect? But it is better than what existed before and it will manage to survive the attacks of those who wish to keep the middle class anxious and the poor under the thumb of the 1%.

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