The federal health care system has become so controversial, that all developments within the system are subject to debate, argument, and spin. For example, the Obama administration this afternoon released new figures on how many Americans signed up for coverage since the start of the open-enrollment period on Oct. 1. What's the total? That's not as simple a question as it might appear.
Over the first month of open-enrollment, 106,185 consumers signed up for health insurance through an exchange -- about a quarter of that total signed up by way of the federal marketplace (the badly flawed healthcare.gov we've heard so much about), while three quarters used state-based exchanges. This overall total is far short of the initial goal of 500,000, but it's actually a litter better than some of the most pessimistic expectations that have been floating around.
(Note, for some on the right, even this 106,185 total shouldn't really count, since these folks haven't actually started premiums yet, but since they've actually signed up for coverage that'll start in January, and chosen a plan, it's not unreasonable to describe them as having "enrolled.")
In addition, another 396,261 Americans have gained coverage through Medicaid expansion.
By this reasoning, about 500,000 consumers gained health insurance in October thanks to the Affordable Care Act, but that's not quite the success story it might appear to be -- the original projections was that 500,000 would sign up for coverage **without** including Medicaid.
Still, this is a cloud with silver linings, and not just because I expected the totals to be worse. Note, for example, that nearly 1 million consumers -- on top of those who gained coverage -- began the process "by applying and receiving an eligibility determination" but have "not yet selected a plan." For many of these folks, this is the result of the broken website -- the totals are not a reflection of demand, but rather, capacity.
And therein lies the point: the administration assumed that that demand for coverage would be there, and those assumptions were correct. The problem, of course, is the dysfunctional website -- people haven't been able to purchase the product they want to buy.
Fix the site and the pieces of the system fall nicely into place. Fail to fix the site and the system deteriorates.
The other factor to consider is time: today's figures, while relevant, only look at October, the very first month of the enrollment period, during a period of a busted website. Every projection shows enrollment picking up -- just as it did in Massachusetts, when its reform system was implemented -- after the first couple of months.
With this in mind, October's totals are interesting, but figures from December and January are important. MIT's Jonathan Gruber, an economist who helped then-Gov. Mitt Romney (R) shape health care reform in Massachusetts, added, "It's too early to say anything useful. And, really, I don't think we can draw any significant conclusions about effectiveness of the law until March, because any firm conclusion requires effects of individual mandate to be felt."