The Obama Administration appears to have reached its goal of getting 9.1 million people covered by the end of this year’s open enrollment period. According to the NYT, in fact, 9.5 million have already signed up for coverage for 2015. The story, however, contains its own caveats:
But in 2014, more than 15 percent of people who selected health plans in the public marketplaces failed to pay their share of premiums and were therefore not on the rolls at the end of the year. Officials said they thought that similar attrition could occur this year […]
But federal officials have a long way to go to meet projections by the Congressional Budget Office, which said on Monday that the number of people in the exchanges would rise to 12 million this year, 21 million in 2016 and 25 million for each of the three years after that.
In addition to those two, there is a third factor that needs to be considered: how coverage actually works for people. Wonks and bureaucrats take a technocratic perspective to health care where official uninsured rates become the primary metric for judging success or failure. But one of the most important thing to do when talking about how well our health care system is working is to adopt the consumer perspective. What are a person’s interactions with our medical system actually like? How much access does his or her coverage get him or her? How much does the coverage cost, either through lost wages or out-of-pocket costs? How efficient is the process? Whether people are “covered” or not doesn’t really answer these questions.
Too few participants in our health care debate asks these questions, in part because such matters cannot be reduced to the easy facts or figures that policy makers need. But the gap between the figures and the reality of the consumer perspective means that things can be troubling on the ground even if they look rosy in the official charts and spreadsheets. Until health care wonks internalize that fact, it will be hard for us to prioritize the best kinds of reforms.