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Lisa Smith (R) helps uninsured Danielle Winters (L) sign up for the Affordable Care Act, or
Lisa Smith (R) helps uninsured Danielle Winters (L) and her 7-month-old grandson Tyler, who is on Medicare, sign up for the Affordable Care Act.
Kaiser Family Foundation's President Drew Altman wants to put the focus on enrollment numbers in perspective, with some good reminders about what the raw numbers of enrollments do, and do not, mean for the future success of the law. Nor, Altman says, does the percentage of young people who sign up.
The six million number is an estimate made by the Congressional Budget Office (CBO) for year one enrollment in the new insurance marketplaces. They downgraded their estimate from seven million after the website woes slowed early enrollment. CBO estimates are made to gauge impact on the federal budget. Their purpose is not to judge the success or failure of the program.  While it is true that the greater the number of enrollees the higher the likelihood of a balanced risk pool, six million is not a magic number. […]

Also, there is no national risk pool, so the percentage of the six million who are young or anything else doesn’t matter all that much. Under the law risk is pooled at the state level, so what matters is the risk profile in each state and there will be variation across the country with more and less balanced risk pools in different states.  Premiums themselves are set on a smaller geographic basis, so they will vary even more depending on market competition and other factors in local markets.

The number isn't unimportant, by any means, but it has probably more political significance at this point—since there has been enough enrollments nationally to sustain the program—than policy significance. The CBO said six million enrollments would be the target for the fiscal stability of the program, so it's become the goal supporters of the law are pushing for and Republicans are rooting against.

But it's at the local and state level where relative success of the program will be determined, and that's not going to shake out for a while. We can make some informed guesses best on health status data about where there will be problems with risk-pools, where the newly insured population is going to be less healthy and more expensive, but at this point we don't really know for sure that, even in those areas, premiums will be driven higher. What we do know, though, is that if they do go up, Republicans will scream about it.

With any hope, Democrats will respond with the policy proposal that could still create the competition needed to help keep premiums overall lower—Medicare expansion or some other public option.

Watching enrollments is still fun for us geeks, so keep up with them at Brainwrap's

Originally posted to Joan McCarter on Mon Mar 24, 2014 at 11:54 AM PDT.

Also republished by Daily Kos.

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Comment Preferences

  •  Tip Jar (19+ / 0-)

    "The NSA’s capability at any time could be turned around on the American people, and no American would have any privacy left, such is the capability to monitor everything. [...] There would be no place to hide."--Frank Church

    by Joan McCarter on Mon Mar 24, 2014 at 11:54:01 AM PDT

  •  The key number (6+ / 0-)

    will be the average cost of health insurance.

    None are so hopelessly enslaved, as those who falsely believe they are free. The truth has been kept from the depth of their minds by masters who rule them with lies. -Johann von Goethe

    by gjohnsit on Mon Mar 24, 2014 at 12:45:13 PM PDT

    •  Agreed (0+ / 0-)

      Few have seen any savings. I know of ONE family who has but that will change for them next year when they start to take money from their retirment accounts.

      •  Several people we know are seeing savings (5+ / 0-)

        because they are eligible for subsidies so their premiums are much lower and their coverage much yes , we know several families and individuals loving it so far.

        Keystone Liberals on Twitter @ KeystoneLibs , Join PA Liberals at

        by wishingwell on Mon Mar 24, 2014 at 02:44:55 PM PDT

        [ Parent ]

        •  The family (3+ / 0-)
          Recommended by:
          nextstep, TofG, musiccitymollie

          I know also got a subsidy.  Not that they need it having a few million in the bank and a Seattle house bought in the 70s.  Husband retired in March of last year and they had so much in their checking account that they had no need to take anything out of savings.  Subsidies are based on income alone and not on assets.

          •  Having a few million in the bank, no matter what, (2+ / 0-)
            Recommended by:
            TofG, Shrew in Shrewsbury

            they will be OK.

            I am thinking about all of those folks who could not afford insurance before , could not even begin to afford the premiums or even to see a doctor or buy a prescription.

            Keystone Liberals on Twitter @ KeystoneLibs , Join PA Liberals at

            by wishingwell on Mon Mar 24, 2014 at 02:59:52 PM PDT

            [ Parent ]

            •  I AM (2+ / 0-)
              Recommended by:
              musiccitymollie, ModerateJosh

              in favor of the ACA but it was poorly planned out.  Of course I am a single payer fan so I admit that I feel what we ended up with was very inferrior.

              •  Ditto, BriarRose. Dems must find a way to (0+ / 0-)

                make needed changes to the ACA, or it could become a real liability.

                What I mostly have in mind is the MERP--Medicaid Estate Recovery Program.  It was always "bad law," but for years, since it pertained only to the very poor, no one seemed to care.  

                I could be wrong, but I can't imagine that once "middle-class" people who have retired "early," [age 55 and older], start enrolling in this program and find out that their respective state Medicaid Program can "recover" expenses medical expenses paid on their behalf, that there won't be a massive "pushback."  

                IIRC, Washington state has set about to change their regulations regarding MERP, but to date, I haven't heard of another state doing so.  Bottom line--all of the states should do away with MERP.  

                Not sure that I even approve of it for long-term care.  But at the very least, it should only apply to very long-term residential/SNF care--not to any other medical services.

                Hopefully, the Democratic Party Leadership will take care of this issue very soon.  

                (They should before the midterms, since I heard this afternoon on the XM radio show "Politics Powered By Twitter," that even Nate Silver's recent projections on the Senate are not looking good for Dems in 2014.)

                I hope everyone calls and writes their Dem lawmakers and the White House on this issue!

                {Pushed--please excuse typos, etc.}


                "Only he who can see the invisible, can do the impossible."-- Frank L. Gaines

                hiddennplainsight--Relaunched 2014!

                by musiccitymollie on Mon Mar 24, 2014 at 03:36:26 PM PDT

                [ Parent ]

            •  This is good news (1+ / 0-)
              Recommended by:

              Since my daughter is very handicapped we spend lots of our time at major medical centers.  It breaks my heart to see the suffering.  One stay in a hospital could bankrupt the majority of Americans.  I am so happy and thankful that these are the people who will benefit from care they would otherwise neglect or wait until it was too late.  We owe Pres. Obama a great deal for this.  The right will never be happy with anything that benefits the general public.  
              If it was so bad there would be real horror story's not the fake,rightie ones.  More people are being employed because of the ACA.  It's a win,win for everyone.

      •  We about break even with the subsidy, but I think (0+ / 0-)

        our coverage is a little bit better.

        If the recovery actually rebounds the way that pundits say it is doing, we could be in deep piles because the unsubsidized price is more than twice what we paid before.

        LG: You know what? You got spunk. MR: Well, Yes... LG: I hate spunk!

        by dinotrac on Mon Mar 24, 2014 at 03:13:22 PM PDT

        [ Parent ]

      •  My family has seen savings (0+ / 0-)

        We actually pay a little more than what we payed before i the open market BUT that includes one more adult with preexistings conditions that was not insured and dental fro the children

    •  How far ACA reduces the 50 million uninsured (3+ / 0-)
      Recommended by:
      rsmpdx, WillR, musiccitymollie

      is a critical number - as this was one of the central reasons for ACA in the first place.

      The most important way to protect the environment is not to have more than one child.

      by nextstep on Mon Mar 24, 2014 at 03:01:19 PM PDT

      [ Parent ]

      •  It is critical--but will anyone get the numbers? (0+ / 0-)

        According to a Forbes Op-Ed (by a right-winger, but Roy quotes "surveys"--and since the WH releases very few numbers, surveys are all that anyone can really go on, at this point),

        Less Than One-Third Of Obamacare Exchange Enrollees Were Previously Uninsured

        Clearly, at some point, the Administration will be forced to release more pertinent data.  And, if by some chance, (and I don't claim to know) these figures are correct, I hope that Dems will make some serious structural changes to the ACA, posthaste.

        Former Dem Governor Brian Schweitzer has some sort of single-payer (almost) health plan proposed, although it is difficult to get the details of it.  Maybe he could help drive home the need to make necessary changes to the ACA, before the next two elections.


        "Only he who can see the invisible, can do the impossible."-- Frank L. Gaines

        hiddennplainsight--Relaunched 2014!

        by musiccitymollie on Mon Mar 24, 2014 at 03:52:40 PM PDT

        [ Parent ]

        •  Gallop has been doing surveys on who is (1+ / 0-)
          Recommended by:

          uninsured for the past few years.  This should hopefully, be covered by US Census so larger samples can be taken to help identify who are the uninsured.

          The most important way to protect the environment is not to have more than one child.

          by nextstep on Mon Mar 24, 2014 at 04:32:56 PM PDT

          [ Parent ]

      •  CBO's February prediction (0+ / 0-)

        was that the uninsured would be reduced by 13 million people.

  •  Does any body have (0+ / 0-)

    a break down to each state age pools?

  •  Texas Republican governor should be ashamed (1+ / 0-)
    Recommended by:

    I would guess that the healthcare premiums in Texas will go up because freakin' Rick Perry and his crony Greg Abbott (who is so proud of suing Obama on a regular basis) refused to help lower and middle class Texans by refusing the federal funds.  

  •  Besides Obamacare, there are lots of successes (4+ / 0-)
    Recommended by:
    wishingwell, Aquarius40, TofG, Jakeston

    that will be seen in this Administration that aren't fully appreciated yet. They'll only be appreciated with enough distance.

    Okay, time for those who disagree now to only bring up the failures. (I saw some knees doing that jerking thing.)

  •  Where is the media?? (3+ / 0-)
    Recommended by:
    wishingwell, Aquarius40, TofG

    After watching the "mainstream" media bobbleheads shit themselves trashing Obamacare when the website didn't work (looking at you, Chuck Todd, David Gregory, Wolf Blitzer, Brian Williams, and the rest of the clownshow), where the FUCK are these people now that Obamacare is getting MILLIONS of people in the United States covered without raising premiums on almost anyone else???

    If I told you in 2008, before the election, that Obama would pass comprehensive healthcare reform getting 5 million Americans covered within the first year of its launch, you would have assumed he'd be on Mt. Rushmore by now.

    But with our broken "Politico" influenced media, any liberal stumble must be trumpeted and every liberal success downplayed to created the fraudulent notion of bipartisanship.

    After all, since Bush was a total disaster, if Obama is a success, and the media reports it that way, then they'll be accused of "bias.."

    And so 50/50 fraud continues.

  •  A friend of mine who was so opposed to ACA now (4+ / 0-)

    says she is happy with her savings.  She was firmly against  ACA from the start. She did not believe in subsidies.  She did not like any part of it, yet she was paying for really bad junk insurance for a very long time. Her insurance was just catastrophic but yet cost her 500 a month for almost nothing but hospitalization.  

    She is saving quite a bit plus she is eligible for subsidies. She is not yet ready to admit she was wrong and she is still very anti Obama and she still may be refusing subsidies out of principle..but I know she is pleased with the lower costs.

    Keystone Liberals on Twitter @ KeystoneLibs , Join PA Liberals at

    by wishingwell on Mon Mar 24, 2014 at 02:43:35 PM PDT

  •  The news media should be ashamed (6+ / 0-)

    Spoke to a middle aged widow today to help her enroll.   She hadn't considered it before--was going to pay the tax penalty--because of all the news reports about how one's personal information on wasn't secure.  She did end up allowing me to complete an application for her (I'm an insurance agent, though health insurance is a small part of my business).  Her subsidized premium ended up being less than $100/mo. with the (subsidized) deductible at $500.  She was absolutely thrilled--had no idea it would that affordable, yet she almost didn't look into it because of the scare tactics on the news.

  •  One major piece of bullshit: (4+ / 0-)
    Recommended by:
    nextstep, TofG, musiccitymollie, AlexDrew
    Also, there is no national risk pool, so the percentage of the six million who are young or anything else doesn’t matter all that much.
    It certainly does matter. Young people are called on to subsidize the old and men are called on to subsidize women and everybody is called on to subsidize those with pre-existing conditions.

    In this case, I'm not talking about the subsidies available on the exchange so much as the enforcement of community pricing that forbids a differential between women and men , a differential of more than 3 times between young and old, and elimination of pre-existing condition exclusions.

    If too few young men sign up, rates have to be higher for everybody else.

    That has a trickle-down effect on the national budget.  Subsidy amounts are not based on insurance costs, but on a percentage of income.  If insurance costs more than expected, that net surplus predicted by the CBO could turn into  a net deficit.

    It all bears careful watching.

    LG: You know what? You got spunk. MR: Well, Yes... LG: I hate spunk!

    by dinotrac on Mon Mar 24, 2014 at 02:54:40 PM PDT

    •  Watch the stock prices of the insurance companies (1+ / 0-)
      Recommended by:

      Their quarterly profits are that really matters after all.

      That's truly the measure of how well the ACA is doing.

      Hillary does not have the benefit of a glib tongue.

      by The Dead Man on Mon Mar 24, 2014 at 03:19:44 PM PDT

      [ Parent ]

    •  It matters less than you think (4+ / 0-)

      Health matters much more than the age.

      The 3x rate differential between the old and young will mitigate most the risks of having an older risk pool.  At worst, it will drive rates a couple of percentage points higher.

      What will really drive down costs is getting healthy people to subsidize the sick regardless of age.  If only sick people sign up in an area, then you can see big rate hikes.  This is more likely to happen where they haven't expanded Medicaid and Republicans suppressed the enrollment efforts.

      Even then, the subsidies will make it affordable for most people including the healthy.  Sure it could drive up the deficit some, but that isn't going to make or break the program long term.

      Once you give people subsidies to buy health insurance, it is really hard to take them away.

      •  I must be subsidizing a buncha folks. (0+ / 0-)

        At 61, I come in the 3X category.
        Admittedly, I did spend a night in the hospital ten years ago.  It was a false alarm, but that doesn't much matter to the costs.

        LG: You know what? You got spunk. MR: Well, Yes... LG: I hate spunk!

        by dinotrac on Mon Mar 24, 2014 at 04:04:11 PM PDT

        [ Parent ]

        •  We are the lucky ones (3+ / 0-)
          Recommended by:
          SMWalt, dinotrac, wishingwell

          I drew a lot out of the insurance pool a bunch of years ago, what with surgery and radiation and stuff. Since then I've been healthy. Frankly I would rather be healthy and "subsidizing a buncha folks" than have the medical problems that I see around me, or taking a buncha drugs every day.

          That's what insurance is -- it spreads the cost of health care (or house fires, or car accidents) more evenly. If you're fortunate, you don't have any catastrophes in your life, so you pay in more than you need.

    •  You're missing the point (1+ / 0-)
      Recommended by:

      The healthy are subsidizing the sick in each risk pool. Everywhere, sick people are signing up, so the issue is whether healthy people sign up to subsidize them. If not enough healthy people sign up, premiums will go up. And that is going to differ by region.

       California is getting robust signups, presumably including healthy people, so we can expect lower premium increases in California. In other areas with anemic enrollment, we can expect premiums to go up more, because there is no national risk pool, only local risk pools.

  •  it's critical (the final number) (1+ / 0-)
    Recommended by:

    because if it hits 6 million, people will believe it to be a success, and will be more willing to sign on next time around.

    •  Actually, IMHO, what is "critical" is how well (0+ / 0-)

      individuals and families are actually served--meaning,"do they receive quality healthcare, at an affordable cost?"

      People will vote their pocketbooks and their health--not statistics (IMO)!



      "Only he who can see the invisible, can do the impossible."-- Frank L. Gaines

      hiddennplainsight--Relaunched 2014!

      by musiccitymollie on Mon Mar 24, 2014 at 03:59:30 PM PDT

      [ Parent ]

      •  people like success/winners (0+ / 0-)

        they don't follow statistics so much.

        If the number were 3 million, the ACA would be in trouble, that it is (probably) going to be 6 million and thus meeting expectations, will help it look like a winner.

        And that matters to people.

  •  Republicans would be screaming (1+ / 0-)
    Recommended by:

    even if the ACA somehow reduced premiums 50% and costs 90%. Reality doesn't matter to these "people."

  •  I know several families the ACA has helped and (0+ / 0-)

    some are Republicans.  Slowly word is getting out and numbers will rise.  

    Do not adjust your mind, there is a flaw in reality.

    by Shrew in Shrewsbury on Mon Mar 24, 2014 at 06:45:46 PM PDT

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