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Editorial: Obamacare Numbers

During the government’s disastrous rollout of the Affordable Care Act’s federal health insurance exchange last fall, the Obama administration’s motto seemed to be, “Keep Calm and Carry On.” Which it did, along with trying to fix its low- to non-functioning website. Now that the first open enrollment period is over, maybe it will change the slogan to “Over 7 Million Served.”

The question, of course, is, how well served? We tend to think pretty well, but the truth is that nobody knows. In fact, most experts think that it will be impossible to accurately assess the ACA’s success or failure for three or four years. Of course, that won’t stop opponents or supporters of the law from claiming otherwise during the fall’s congressional election campaigns.

But more about that later. First the numbers. As of Monday’s deadline, the White House said, 7.1 million people had enrolled in private insurance plans through the virtual marketplaces established under the law. An additional 3.5 million Americans have become newly insured under Medicaid, according to independent analysts.

This is in many ways remarkable, considering that the ACA represents a vast social experiment, that its opponents have done all in their power to sabotage it and that the bungled rollout of the federal health exchange website constituted an object lesson in bureaucratic and technical failure. That the administration was able to redeem its sign-up goal despite all that is testimony that the law addresses a pressing social problem: that millions of Americans lack affordable health insurance.

Only time will tell if Obamacare addresses this problem in the right way, or more precisely, the most feasible way given the nation’s political divisions. In the immediate future, questions to be answered include whether those who have signed up continue to pay their premiums; whether the newly insured have access to the hospitals and doctors they want (a factor to be watched closely in New Hampshire, with its limited network of providers); and what effect the newly enrolled will have on insurance premiums. Insurance companies will be analyzing their risk pools with an eye toward deciding what products to sell and what prices to charge when the next open enrollment period begins in November.

Meanwhile, as The New York Times reported in an extensive survey and perceptive analysis last week, Obamacare so far “looks less like a sweeping federal overhaul than a collection of individual ventures playing out unevenly, state to state, in the laboratories of democracy.” In fact, how well it’s working seems to depend almost entirely on where a person lives.

There are many reasons why. Some states that embraced the law and ran their own online marketplaces, such as Connecticut, were highly successful in enrolling consumers. States that resisted Obamacare on ideological grounds and ceded running their exchange website to the federal government often enrolled less than 10 percent of the potential market. In some states, such as Maine, there has been vigorous competition among insurers, including nonprofit co-ops that have captured market share with low prices, while in others, such as New Hampshire, consumers have little choice. Vermont, which is supposedly on the road to universal, single-payer health care, led the nation in the percentage of the eligible market that signed up, at 54 percent.

Nor does anecdote serve to clarify the situation. In its reporting, the Times found that every success story about an individual finding affordable coverage had its disgruntled counterpart.

While this all shakes out, of course, there are political campaigns to be run. Republicans are banking on Obamacare remaining deeply unpopular. But with more than 7 million Americans enrolled, their problem now is to follow their call to repeal the ACA with a plausible alternative. This is not going to be easy for a party whose current answer to every problem in America is embodied in three words: “Cut food stamps.”

And during the campaign, those with long memories, or acquaintance with the historical record, may recall that just about everything dire now being said about Obamacare was also said about Social Security and Medicare in their infancy. And they grew up to be pillars of society.