Tuesday, November 12, 2013

"Obamacare" is not just healthcare.gov

There seems to be a sense that "Obamacare" means the federally-run individual market exchange, that is healthcare.gov. That definition leaves out most of the Affordable Care Act. So, for example, the Wall Street Journal's report that only 40 to 50 thousand have enrolled in health insurance through healthcare.gov is cited as evidence that there is only a "tiny enrollment for Obamacare."

Obamacare has three major parts: (a) revamped regulation of all private health plans, (b) expansion of Medicaid, and (c) the establishment of health care exchanges and the mandate for the individual market. (a) and (b) affect a much larger number of people than (c). About 6% of Americans are expected to gain insurance through the individual market under the ACA. The WSJ's 40-50k does not include anyone now qualifies for expanded Medicaid. By counting only the people who got insurance through healthcare.gov, it also does not include the people who purchased insurance from the 12 states, plus D.C. that have set up their own exchanges. That means the WSJ's number does not take into account people seeking to buy insurance in states with small populations like California or New York. If you want the real total number of people who have purchased or receive insurance because of the ACA, a crowd sourced attempt to count that is here (as of this writing, it calculates a total of 962,144 people have gained insurance from the law).

I'm not saying that Obamacare is a success or denying that the law has plenty of problems. I just find it interesting how much focus there is on a relatively small part of the law in terms of the number of people it will directly affect. Also, as I said before, i think it is premature to declare whether the individual marketplace portion of the law is a failure just by these preliminary exchange sign up numbers. Most people who buy coverage would probably be inclined to do it last minute. That's even more true with all these reports of web site glitches. If I needed to purchase a policy from the federal exchange, I would wait until the kinks get ironed out before I gave it a shot. The deadline is still weeks away. The real test for the law will come at the end of the year, when we will see whether the expected last minute rush in the exchanges ever materializes.