We had a pretty good sense of ACA enrollment numbers shortly before New Year's, but the Obama administration fleshed out the details in a new report (pdf) this afternoon. The topline looks pretty good for the law's proponents, though the data is not without caveats.
Nearly 2.2 million people have selected plans from the state and federal marketplaces by Dec. 28, 2013 (the end of third reporting period for open enrollment), Health and Human Services Secretary Kathleen Sebelius announced today. A new HHS report provides the first demographic information about enrollees. December alone accounted for nearly 1.8 million enrollees in state and federal marketplaces. Enrollment in the federal Marketplace in December was seven-fold greater than the combined total for October and November -- and eight-fold greater for young adults ages 18 to 34.
Remember, this only refers to consumers who signed up for coverage through exchange marketplaces, and doesn't include another 3.8 million Americans who took advantage of Medicaid expansion or became insured through other "Obamacare" provisions.
Also note, the White House assumed all along that enrollment would escalate quickly as Jan. 1 approached -- and once healthcare.gov functionality was on track -- which is precisely what happened.
But as we dig deeper into the latest figures, related questions arise. It's true, for example, that the 2.2 exchange enrollees are below the projected targets set before the open-enrollment period began. Then there are demographic concerns -- about one-in-four enrollees are between the ages of 18 and 34, which isn't horrible, but it's a little below what the administration hoped for, and reinforces suspicions that it's older consumers who are the most eager to sign up.
That said, keep a few angles in mind.
First, I've never been altogether convinced the demographic challenges matter that much, at least not at this phase. As Jonathan Cohn explained this afternoon, "In Massachusetts, according to analysis from MIT economist (and Obamacare architect) Jonathan Gruber,younger people tended to sign up later. The same thing seems to be happening in Colorado, one of the states that's kept close records on age. Sarah Kliff has that story at the Washington Post. And thanks in part to Obamacare's built-in shock absorbers -- such as a 'risk corridor' program that compensates insurers for greater-than-expected losses -- the danger of low enrollment among young people isn’t as great as commonly thought. As John Holahan, Urban Institute scholar and co-author of a report on the subject, told me recently, 'It's a problem if it goes on forever, but it's not a problem if it's just year one and if enrollment is improving over time ... The system can handle it.'"
Second, by some independent estimates, enrollment totals at these levels reinforce the sustainability of the exchange marketplaces.
And finally, if Republicans believe their repeal crusade can persevere going forward, they're living in fantasy land. It's genuinely absurd to think GOP candidates will spend the next 10 months telling the public, "Our message to the millions of Americans who've signed up for coverage is simple: vote Republican so we can strip you and your family of the ability to receive affordable health care."
Indeed, this afternoon, I can think of 2.2 million reasons why the right-wing repeal crusade is gone -- and it's not coming back.