It's a complete accident of legislative and administrative history that the fourth anniversary of the Affordable Care Act should fall the week before the end of the law's first ever, six-month-long open-enrollment period. But it's a great coincidence for those of us in the business of cutting through all the hyperbole that accompanies each ACA anniversary, because, for the first time since the law passed, there are real data, and real beneficiaries, to hold up against the spin.
And as I've been arguing for months now, the GOP's position on the law can't actually withstand on-the-ground realities.
Case in point: Terri Lynn Land -- Michigan's one-time Republican secretary of state, turned Senate candidate -- held a first-ever conference call with reporters to trash the ACA on its fourth birthday. But confronted with the question of what happens to people with preexisting medical conditions if the GOP repeals the law (and thus eliminates the individual mandate) -- Land's press aide, Heather Swift, commandeered the call, and tried to take the whole thing off the record.
I wasn't on the line, but Michigan Information and Research Service posted the audio here. (The call starts at 19:20 and the preexisting conditions question at 39:15.) I think the biggest tell of all is that Land doesn't seem remotely prepared to address the real human consequences of repealing the law herself in any meaningful way. But almost as big is that her staff can't either. The aide who leapt to Land's defense made a glaring error after attempting to take the call off the record.
"I can follow up with you more on this with a little bit more policy research, but just off the record the characterization of this question is incorrect," she said. "It’s not the individual mandate but it’s the guaranteed provision that prohibits the denial of coverage from preexisting conditions. The problem with Obamacare is that it allows people to wait until they’re very sick to purchase insurance, which creates significant and unknown risks to insurers and then the insurance companies would pass that cost on to consumers. So the way that Terri’s plan, and then this can be on the record, the way that Terri’s plan addresses preexisting conditions is continuous coverage and portability."
I don't know if that was intentional or not, but it's wrong, and actually potentially dangerous. It's true that the ACA requires insurers to sell to all eligible beneficiaries, regardless of their health status, and prohibits them from charging sick people more than healthy people. Anyone who's shopped on the exchange should have noticed that, because of these provisions, the application contains no medical underwriting form. But the law also establishes annual open-enrollment periods. The one we're in now is an unusually long six months, but future open-enrollment periods will be significantly shorter. And unless you happen to get sick during an open enrollment period, you can't just wait to get sick to enroll. Anyone who decides to skip Obamacare, and then gets sick or injured in April, will be on the hook until Nov. 15, when the open enrollment period for coverage starting in 2015 begins.
Land's ideas, by contrast, would guarantee coverage for people who have insurance and sick people who can afford it, but would lock people who allow their coverage to lapse, even if for financial reasons, and those who can't afford it in the first place, out of the system permanently.
Meanwhile, in the world of existing policy, the Affordable Care Act is experiencing an enrollment surge.
Charles Gaba -- an ACA supporter and data Hoover -- has been documenting the March surge, state by state on his Twitter account and his site, ACAsignups.net. Gaba has the best numbers out there, and has been accurately forecasting official enrollment statistics for weeks. He currently projects total exchange enrollment will hit 6.2 million by the end of the month, not counting enrollment in off-exchange plans, and puts the grand beneficiary total (including Medicaid beneficiaries and "young invincibles" on their parents' plans) at 11.9-15.6 million as of Saturday. Conservatives are thus, to no one's surprise, furiously attempting to "un-skew" his figures.
And, as Vanderbilt health policy and med school professor John Graves notes in Health Affairs, turnover is a major hallmark of the insurance market. People who lose or change jobs, and thus become temporarily uninsured, will be eligible for ACA enrollment, even after March 31. Medicaid, isn't bound by open enrollment. As such, enrollment numbers will continue to grow throughout the election season. Exchange beneficiaries might even reach the elusive 7 million total this year, a few months late, but before the midterms.
And GOP candidates still won't have answers for them.