November 19, 2013
Americans Like Obamacare Where They Can Get It
Posted by John Cassidy
As the Washington press corps reports that the Obama Administration is failing—and threatening to take down with it the entire philosophy of liberalism—a funny thing is happening out there across the country. In a number of states that have working online health-care exchanges, more and more people are signing up for the insurance coverage that is available under the Affordable Care Act.
In California, where local officials have launched a campaign to remind residents that the state’s new Web site, Covered California, is separate from the troubled federal site healthcare.gov, enrollment is rising fast. During the first two weeks of November, almost sixty thousand people signed up for private insurance policies or for Medi-Cal, the local version of Medicaid. That’s more than twice the figure for all of October. “What we are seeing is incredible momentum,” Peter Lee, the director of Covered California, said at a press conference on Monday.
Similar things are happening in other states across the country. An article in Tuesday’s Los Angeles Times cites Connecticut, Kentucky, Minnesota, and Washington as on track to exceed their enrollment targets. Here in New York, too, there are positive signs. Last week, officials reported that close to fifty thousand people had signed up for health insurance through the state’s new Web site, NY State of Health, with about half of them taking out private plans and half enrolling in Medicaid. “I would say we are seeing great interest in New York, and we are very pleased with our enrollment numbers,” Danielle Holahan, the deputy director for NY State of Health, said.
What these states have in common are state-run Web sites that are working pretty well; they are also all controlled by Democrats who are pushing the new reform. This progress points to something that has been absent in much of the reporting about the troubled rollout of healthcare.gov and the cancellation of individual policies: in places where Americans know about the comprehensive and heavily subsidized health coverage available under the Affordable Care Act and can easily access it, they are doing so in substantial numbers.
That’s hardly surprising. Prior to the reform, close to fifty million Americans didn’t have any health-care coverage, and many others were stuck with policies that had large gaps. The online insurance exchanges and the effort to make more people eligible for Medicaid were designed to remedy this situation, and in some places that strategy is working more or less as planned.
For many low-to-middle-income individuals and families who don’t qualify for Medicaid, the provision of generous subsidies means that they can afford new private insurance policies. Consider, for example, a family of four in Sacramento, California, with two thirty-five-year-old adults who earn a combined fifty thousand dollars a year, which is roughly the median household income nationwide. If this family took out the “silver level” plan offered on the Covered California exchange, it would pay about two hundred and eight dollars a month, according to the Kaiser Foundation’s cost calculator. (Most of the policy would be covered by the federal government, which would send the insurer a monthly check for about nine hundred and eighty dollars.)
Where private insurance plans are affordable and readily available, they are sure to be popular. And that’s only part of the story. The success some states are having enrolling people in Medicaid is another development that deserves more attention. In Oregon, for example—which is one of twenty-five states registering adults who weren’t previously qualified for the jointly funded federal-state program—more than seventy thousand people have already been signed up. It’s probably fair to assume that prior to last month many of these folks didn’t have any coverage.
To be sure, we need more information about who is signing up, particularly for private plans. For the new insurance exchanges to work properly, the risk pool has to be a broad one. It could be problematic if the enrollees are mainly elderly, or people with preëxisting conditions. But that doesn’t detract from the news that, in some places, the launch of A.C.A. is actually going along pretty well.
Nationwide, the big problem with the rollout is that many of the potential winners from the reform don’t yet have access to it. Many of them live in Republican-controlled states, which haven’t set up their own online exchanges and which refused the Obama Administration’s offer to meet most of the costs of expanding Medicaid. For these folks, the only option is trying to get onto healthcare.gov, or calling one of the federal help lines, and it's not one that their local political leaders have encouraged them to pursue. As a result, the take-up has been dismal. In Texas, for example, only about three thousand people have signed up for new individual plans, and the state isn’t expanding Medicaid.
That’s an indictment of the Republican Party, and it’s also an indictment of the Obama Administration, which was well aware of how much hinged on healthcare.gov working properly. The news that, back in March, some consultants at McKinsey & Co. warned Administration officials that the rollout of the site was at risk because of insufficient time for testing, among other issues, is another damaging revelation. (Quite how bad isn’t clear. At least some of the consultants’ warnings appear to have been addressed.)
So, by all means, let’s find out who screwed up and why it happened. But let’s also keep in mind the bigger picture. Before the passage of the Affordable Care Act, America’s health-care system, particularly the individual-insurance part of it, was not functioning well. At this early juncture, neither is its replacement. But in those parts of the country where Obamacare is up and running, there are some encouraging signs.
Above: Janelle Arevalo, an insurance agent with Sunshine Life and Health Advisors, makes a house call to sign up Sandra Berrios for an insurance plan under the Affordable Care Act. Photograph by Joe Raedle/Getty
