Aaron Carroll: Exchanges one week old: some tout success, others say disaster
He says those rooting for failure point to big problems with getting onto exchanges sites
He says, problems aside, people are visiting and many are signing up, which was the point
Carroll: If government doesn't quickly fix access issues, people will feel bad about law
Editor’s Note: Dr. Aaron E. Carroll is a professor of pediatrics at the Indiana University School of Medicine and the director of its Center for Health Policy and Professionalism Research. He has supported a single-payer health system during the health care reform debate. He blogs about health policy at The Incidental Economist and tweets at @aaronecarroll.
After years of waiting, Obamacare finally fully opened for business last week. After three and a half years, Americans who were uninsured or underinsured could go to the health insurance exchanges to sign up for private plans or enroll in the Medicaid expansion. Depending on whom you listen to, this was a huge success or an ongoing disaster.
For months, those opposed to the law have been encouraging Americans not to buy insurance in an exchange. They have predicted that rates would be far higher than people think, and they have touted the stories of young, healthy people who have seen rates for more comprehensive insurance roll out with premiums far above what might have been available earlier. Some have even gone as far as to urge young people to burn their Obamacare draft cards (which don’t really exist).
The massive problems that have plagued the exchanges since they went online last Tuesday may well have given fresh fodder for such arguments. The first day just about anyone visiting the federal site got an error message and many waited all day without successfully signing up for a plan. Things haven’t gotten much better over the course of its first week.
The government has, so far, refused to release any statistics on how many people have managed successfully to sign up for coverage. Given that reporters have been beating the bushes looking for some who have, it’s likely the numbers are far less than the administration would like.
But that’s not for a lack of trying. There is news to give supporters hope. It appears that the reason things have been so bad is because there is massive interest in the exchanges. Tens of millions of visits to the sites overwhelmed their technical aspects. This type of interest may show that many more people than expected might sign up for coverage. That’s certainly good news for those that want the law to succeed.
Moreover, there have been reports of many more people successfully navigating the state-run exchanges than the federal exchange. While not comparable to the millions of visitors reported visiting sites, these early numbers are heartening to those that want to see Obamacare flourish. People are signing up for insurance. As of 3pm ET Monday, at least 95,801 people had created accounts which allowed them to explore what coverage options are available to them. This is based on information provided by individual states who responded to CNN.
That’s what the Affordable Care Act was all about.
It’s still early. People have until December 15th to sign up for insurance policies that will go into effect on January 1. Even if they don’t by then, the enrollment period for the first year extends into March, so people can still sign up for coverage in 2014.
Insurance isn’t something that people should buy on an impulse. There are many variables to consider, including how much people can afford in premiums and how much they’re willing to accept in terms of deductibles, co-pays and co-insurance. So no one should expect, or encourage, people to rush into a decision. They should take their time.
For the last few weeks, those who are most opposed to Obamacare have done everything in their power to stop the law from going into effect. They knew that once the exchanges and the Medicaid expansion opened, it would be almost impossible to stop the law. It would be far easier, politically, to stop people from signing up for insurance than to take it away from them after they got it.
The government shutdown we are now experiencing was the final threat to prevent Obamacare from fully opening. It failed. While the government is now defunded, Obamacare is not. It’s gone into effect.
Even more ironically, the shutdown has given Obamacare a surprising public relations boost. Had the government not closed, it’s likely that most of the news stories of the last week would have focused on the exchange rollout. Since that’s gone so poorly, from a technical standpoint, the news would have been flooded with stories of Obamacare’s failures and problems.
Instead, we’re watching stories about the fight between the Democrats and Republicans over the shutdown and between traditionalist and hardline conservatives in terms of strategy. Those most opposed to the law unwittingly handed Obamacare a huge gift, while the rest of the country suffers.
But the government has a lot of work to do. The websites still don’t work well. The last time I visited my state’s exchange, which is hosted by the federal government, I still couldn’t get on to see plans. People may give the site some slack at the beginning, but as time goes on, they will become more and more annoyed at technical difficulties. And bad feelings about the site could translate into bad feelings about the law in general.
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The opinions expressed in this commentary are solely those of Aaron Carroll.