(Reuters/Larry Downing)

Good news for Obamacare: Here's what's needed to keep it going

Healthcare.gov is working well enough to enroll tons of people, but Obamacare isn't out of the woods yet


Brian Beutler
December 6, 2013 5:43PM (UTC)

On Sunday and Monday, 29,000 people signed up for insurance on Healthcare.gov, according to Obama administration officials. On Tuesday alone, another 27,000 followed suit. At this rate, by Dec. 23, every man, woman and child on Earth will have signed up on Healthcare.gov for coverage that begins on the first of the year.

Amazing, right?

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Actually, the latest numbers -- which administration officials are all of a sudden so eager to leak for some reason -- really demonstrate three things. One is that it's easy to torture scarce and selectively leaked data to fit just about any preconceived narrative. Another is that Healthcare.gov's terrible rollout didn't completely discourage people from giving the site a second look, let alone destroy the demand for health insurance across the country. Third is that, simply by leaking, administration officials demonstrated some degree of confidence that the worst of their implementation woes are behind them.

That's all basically good news. But it's really all we can say for now. And it doesn't prove that the Affordable Care Act is completely out of the woods yet.

The optimistic scenario is that enrollment accelerates, or at least settles into a favorable trend: higher figures during the week than on weekends, and significantly more enrollments each week as the Dec. 23 "deadline" approaches. That the administration increases the site capacity, that the per-page error rate decreases and that the administration and the contractors building out the site fix the line of communication between Healthcare.gov and insurance companies -- the so-called 834 transmissions -- so that when people complete enrollment, their new insurers know it.

If things develop in this way, or along some similarly healthy track, I suspect we'll know it very quickly. If enrollment accelerates or even holds relatively steady I imagine we'll see many more, and more frequent leaks. If the 834 error rate plummets, we'll hear about it.

But remember, there was a tremendous amount of hype surrounding Dec. 1. The Obama administration all but promised that by the end of November Healthcare.gov would be working well "for the vast majority of people." The media thus quite understandably treated Dec. 1 as something like the grand reopening of the site. Given all the attention, it's no surprise people flooded back right after Thanksgiving. And there's thus a corresponding danger that the promising figures this week will taper off in the middle of the month. And if that's the case, I imagine we'll probably have to wait until January to know how well things are truly going.

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But even if tons and tons of people make it through Healthcare.gov from beginning to end before the first of the year, that doesn't mean Obama can kick up his heels and watch the Affordable Care Act story and opinion polls turn in his favor. It's very possible, even likely, that in January we'll be treated to a rash of stories about people showing up at hospitals and doctors offices, believing they were insured, only to be turned away or billed for expensive services for which they assumed they were covered.

The administration is scrambling to solve this very damaging problem. The Department of Health and Human Services will be reaching out to enrollees to remind them to circle back to their carriers and pay their first month's premiums so everyone's on the same page. But the administration should gird itself for the possibility that thousands of people will still be left in the lurch, and justifiably angry about it. As Huffington Post healthcare reporter Jeffrey Young noted, "Insurance companies could smooth over difficulties during the first month of new coverage by paying the expenses of people who believed they were enrolled. But that would subject the companies to potentially big costs for patients who get expensive services without having yet paid a premium, or who may not be their customers at all."

Doctors and hospitals could also absorb some of the burden by providing services and sorting out billing later, once HHS, insurers and beneficiaries are all squared away. Even still it's almost a fait accompli at this point that some large number of people seeking care will complain in frustration to the press, much like in 2006 when seniors showed up at pharmacies to redeem their prescription drug benefit and found that it hadn't really been established yet.

Only, this time, instead of working constructively to help these putative beneficiaries, one of the two major parties will only be eager to exploit their woes for political gain. And who knows how many prospective beneficiaries that will scare off before the open enrollment period closes at the end of March.

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Brian Beutler

Brian Beutler is Salon's political writer. Email him at bbeutler@salon.com and follow him on Twitter at @brianbeutler.

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