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A man fills out an information card during an Affordable Care Act outreach event hosted by Planned Parenthood for the Latino community in Los Angeles, California September 28, 2013. REUTERS/Jonathan Alcorn
The New England Journal of Medicine rounds up what we know so far about the first enrollment period in the Affordable Care Act so far, and most of the news is good. The best of the news is the numbers—20 million total enrollees under the law.
Chart showing make-up of 20 million new Obamcare enrollments between Medicaid, and on and off exchange private insurance
Those are blockbuster enrollment numbers, considering the very bumpy start. But there's more to evaluating how the law is doing than raw enrollment numbers. Head below the fold to find some of the things analysts are looking at.

Some of the key findings:

  • Surveys show that 7.8 million young adults, 19-25 years, were enrolled in a parent's plan and that most of them wouldn't have been able to do so before the law. The result, according to federal studies, is that the number of uninsured young people dropped by 1 million since the law took effect, with 3 million now uncovered. A fun tidbit—more of these young people covered by their parent's plans identified themselves as Republican than Democrat in a Commonwealth survey.
  • The health insurance market off of the exchanges that was set up under the law had a robust year, with the CBO projecting 5 million people gaining coverage outside the exchanges. That's directly attributed to the law's passage, both the individual mandate that people must have coverage and the fact that insurance companies now can't charge huge premiums or shut people out of insurance entirely because of their health status.
  • The enrollment numbers for 2014, and the risk-sharing provisions of the law that help equalize the coverage burden for insurers, should mean modest premium increases for 2015—Kaiser Family Foundation says they could be as low as 1 to 2 percent.
  • One of the things keeping premiums low could be a problem going forward: many plans have very narrow networks of providers they'll cover services from. Some people will probably leave those plans if they find that they're not getting access to the doctors and hospitals they want or need and might not be able to afford a plan with a larger network. The administration and the several of the states are looking at how much of a problem these narrow networks are, and what can be done to address the problem.
  • So far, 6 million people—adults and children—have gained Medicaid or CHIP coverage. That number will keep increasing because people can sign up for it at any time, and it includes people in the non-expansion states who discovered they were eligible for traditional Medicaid when they tried to enroll in an exchange. These authors are optimistic about the non-expansion states eventually coming around. They point out that it took about six years for most states to opt in to Medicaid after it passed in 1966, and Arizona waited until 1982.

The authors caution that this is just a status check, not a measure of success or failure of the law, because it's really too soon to say how it's going to play out in the coming months and years. Beyond that, the experience among the states already has and is going to continue to differ. Gallup has already shown that states that embraced the law, worked to make the exchange work and to get the word out, and expanded Medicaid have less of a problem with uninsured rates.

Ultimately, though, they say the success of the law is going to be determined by whether the government and the industry can reduce costs in the system, and that "developing and spreading innovative approaches to health care delivery that provide greater quality at lower cost is the next great challenge facing the nation." Healthcare reform is far from done now.

Originally posted to Joan McCarter on Thu Jul 03, 2014 at 11:23 AM PDT.

Also republished by Obamacare Saves Lives and Daily Kos.

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Comment Preferences

  •  Tip Jar (41+ / 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 Thu Jul 03, 2014 at 11:23:39 AM PDT

  •  20 million covered total....cue republican head... (4+ / 0-)
    Recommended by:
    TopCat, FloridaSNMOM, murrayewv, khyber900

    20 million covered total....cue republican head explosions followed by various shouts of "But HOW MANY HAVE PAID?!!! followed from there by, "hey look over here, we are still investigating BENGHAZI!!!!

    You lost the healthcare debate conservatives. Give it up, you couldn't keep subsidized health insurance from the poor and middle class out of spite any longer.

    •  bluenick, (2+ / 0-)
      Recommended by:
      FloridaSNMOM, bluenick
      cue republican head explosions
      Cue me lighting the fuses.
    •  Unfortunately, the Republican Obamacare haters (2+ / 0-)
      Recommended by:
      KenBee, Waimer

      may get a second chance to kill the law, or fatally wound it, at the Supreme Court.

      Decision Looms In Lawsuit That May Actually Crush Obamacare:

      Obamacare was left mostly unharmed this week despite the fact that the Supreme Court ruled against its contraception mandate. But a far greater threat to the law is alive and well a few blocks away in Washington, D.C.

      Any day now, a three-judge panel on the D.C. Circuit Court of Appeals is expected to rule in Halbig v. Burwell, an expansive challenge that goes directly after federal insurance subsidies. An unfavorable outcome stands to cripple a core component of Obamacare, without which the law may not be able to survive. Two of the judges, both Republican appointees, expressed varying degrees of sympathy for the challengers' case.

      "Of all the challenges since the individual mandate, this is the one that presents the most mortal threat to the act," Jonathan Turley, a professor at George Washington University Law School, told TPM.

      “I would like to get rid of the homophobes, sexists, and racists in our audience. I know they're out there and it really bothers me.” ― Kurt Cobain

      by Jeff Y on Sat Jul 05, 2014 at 12:45:00 PM PDT

      [ Parent ]

      •  It's entirely ratfucking from the bench if the ... (2+ / 0-)
        Recommended by:
        Tommy Aces, sotiredofusernames

        It's entirely ratfucking from the bench if the court buy that line of crap. It doesn't say "the states" (of which there are 50 and the District of Columbia). It says "the State" (specifically capitalized in the statute). The fact that you can't even identify *which* state is being refered to from the text tells you all that you need to know.

        •  The term "State" is defined (0+ / 0-)
          The term “State” means each of the several States, the District of Columbia, Puerto Rico, the Virgin Islands, Guam, American Samoa, and the Northern Mariana Islands.
          42 U.S.C. sec. 300gg-91

          Bin Laden is dead. GM and Chrysler are alive.

          by leevank on Sat Jul 05, 2014 at 01:30:03 PM PDT

          [ Parent ]

      •  why is it only a 3-judge panel? (0+ / 0-)

        Why doesn't the whole DC circuit taking it up?

        I don't get what the difference is. If the states (small "s") had developed their own exchanges the credits would have been issued. So what difference does it make if they go through a federal exchange instead?  The law can't help that some states chose to be assholes, but the intent behind subsidies remains the same.

        What exactly are the judges "sympathetic" to?

  •  Question: In CA my group healthcare provider (0+ / 0-)

    KAISER is stating that the waiting period for new hires has been increased from 30 to 60 days.

    Or not. Perhaps that's what my RW HR person is saying. lol.

    Does anyone know if Obamacare effected this change?


    “I’d put my money on the sun and solar energy. What a source of power! I hope we don’t have to wait until oil and coal run out before we tackle that.” Thomas Edison, 1931

    by nzanne on Thu Jul 03, 2014 at 12:10:00 PM PDT

    •  No, because employer insurance like you have (0+ / 0-)

      was already a pretty good deal. So your boss saying you must wait 60 days is just your boss being a jerk.

      Obamacare covers individual policies for the self employed, independent contractors etc, because we couldn't get it if we had been sick etc.

      Thanks Democrats! My Obamacare is permanent coverage no one can take away - and saving $3,000 is nice too

      by sotiredofusernames on Sat Jul 05, 2014 at 09:57:33 PM PDT

      [ Parent ]

  •  Plus, Best Six Months of Job Creation Since ... (4+ / 0-)


    Earlier today, RNC Chair Reince Priebus issued the following statement on the June jobs report: "We need a Republican majority in the Senate so we can get ... job-killing policies like ObamaCare out of the way of American workers." This is the same talking point the GOP has been using since 2010, when the House Republicans issued a 43-page report claiming that Obamacare was already hurting the private sector and killing jobs.

    If one accepts the Republicans' argument that the economic debate should be framed around Obamacare, here are the relevant before/after numbers:

    Chart: After losing 3.6 million jobs in the decade before Obamacare, the private-sector has gained 9.6 million jobs since Obamacare became law.
    Chart: The private sector was losing nearly 800,000 jobs per month before passage of the 2009 Recovery Act (President Obama's stimulus law). Within a year of the Recovery Act's passage, the private sector was gaining jobs again, and it has created jobs ev
    Chart: Deficit drops from 9.8% of GDP before Obamacare to 2.8% of GDP in 2014.
  •  lack of providers caused MsBee to jump (1+ / 0-)
    Recommended by:

    then in norcal Anthem BC iirc promised scads of providers and yet they weren't signed up. Patients are screwed for the bills they thought they wouldn't have and can't pay for. And blame ACA for it and anybody close to it in their pain...and the usual suspects amplify and distort it too.

    Medical bankruptcy for those people should NOT be an option, they were lied to and they need to be covered by some provision somehow.
    These are blamed on teething problems or some such claptrap, but for an experienced company like that, that 'mistake' is not acceptable and they need to square it with those people affected whatever the cost.

    Nice chart Joan.

    This machine kills Fascists.

    by KenBee on Sat Jul 05, 2014 at 12:12:59 PM PDT

    •  I keep hearing this (2+ / 0-)
      Recommended by:
      KenBee, hbk

      Have people in California complained to the state insurance commissioner about this misrepresentation by Anthem BC/BS? Everybody who has had this experience should complain about their false advertising.

      Bin Laden is dead. GM and Chrysler are alive.

      by leevank on Sat Jul 05, 2014 at 01:33:51 PM PDT

      [ Parent ]

      •  yes being investigated (1+ / 0-)
        Recommended by:

        article was in a recent edition of the North Coast Journal from Humboldt County, Anthem bcbs is widespread in northern california, 90% IIRC, a good article, easy to find..

        This machine kills Fascists.

        by KenBee on Sat Jul 05, 2014 at 02:01:24 PM PDT

        [ Parent ]

  •  Does this mean now we can't (2+ / 0-)
    Recommended by:
    PinHole, OuijaForestCat

    The superfluous goods of the rich are necessary to the poor, and when you possess the superfluous you possess what is not yours." St. Augustine

    by Davis X Machina on Sat Jul 05, 2014 at 12:21:59 PM PDT

    •  Threads are like that are hilarious today. (0+ / 0-)

      I was one of those millions of liberals in 2009 who said stuff like

      "If it doesn't have a public option then it's reform in name only."
      "Mandating payments to for-profit corporations is unacceptable to my liberal principles."
      I was one of those weirdos who actually fucking meant it when I said that stuff.  I still do.  The other 90% who said it turned out to be bullshitters.  Markos is a fine example.
      •  I for one... (1+ / 0-)
        Recommended by:
        Tommy Aces

        ...don't think any price in avoidable pain and human suffering is too high a price to pay to kill off the health insurance industry.

        Provided it's not my avoidable pain and human suffering, of course.

        No revolution without martyrs. So long as I'm not one of them.

        The superfluous goods of the rich are necessary to the poor, and when you possess the superfluous you possess what is not yours." St. Augustine

        by Davis X Machina on Sat Jul 05, 2014 at 02:50:49 PM PDT

        [ Parent ]

  •  But how are health insurance stocks doing? (1+ / 0-)
    Recommended by:

    Hillary does not have the benefit of a glib tongue.

    by The Dead Man on Sat Jul 05, 2014 at 12:35:34 PM PDT

  •  Speaking from personal experience, (8+ / 0-)

    our paperwork was a bit of a mess and still is not fully straightened out. That's the bad news. The good news is that we have about the same care and copays as we had under my COBRA, and we pay $800 less per month. $800 x 6 = $4800; kind of a BFD when you're unemployed.

    •  very good and becoming very typical (5+ / 0-)
      Recommended by:
      PinHole, jrand, jck, hbk, sotiredofusernames

      we have saved about $420/month...also very good for us.

      we spend it, it goes around and around.

      doctors seen for things that should have been looked at years ago

      car actually locks now, driver can open the door by actually using the handle

      tires have actual tread, engine not about to strand us in the truck.

      Shoes don't have holes where there shouldn't be, sox, same

      and when MsBee turns 65 she will  have less of a burden to throw at Medicare unlike before, where the survivors instantly try to get 10-15 years of deferred healthcare taken care upon reaching 65.

      If they do.

      This machine kills Fascists.

      by KenBee on Sat Jul 05, 2014 at 01:01:39 PM PDT

      [ Parent ]

  •  BCBS of NC (2+ / 0-)
    Recommended by:
    KenBee, hbk

    that's who I am using now, I will find another company. Their payment site always tries to get me on an auto payment plan. I don't want that,

    So I'll change companies in 2015

  •  just saw this part in a minimum wage article (3+ / 0-)
    Recommended by:
    jrand, hbk, sotiredofusernames

    but it perfectly describes the same effect the ACA is having on us..

    The more money minimum wage earners have, the more they will spend.

    Those without cars get cars; those with cars get better cars.

    Those who live out of their cars or in tents get a place to rent.

    Those who live in gawdawful rentals move up to awful rentals.

    Those who live in awful rentals move up to minimal but decent housing.

    They buy more and better food and so are healthier and less inclined for themselves and their families to be a drain on medical resources (like the ER).

    This machine kills Fascists.

    by KenBee on Sat Jul 05, 2014 at 01:21:01 PM PDT

  •  Why didn't we just do the Medicaid expansion and (0+ / 0-)

    skip the rest of this crappy law?    ACA is basically a giant shit sandwich with a Medicaid expansion attached to it.   Why didn't we skip the shit sandwich?

    •  Well, for me, I'd rather not DIE (3+ / 0-)
      Recommended by:
      Tommy Aces, BelgianBastard, doroma

      Due to multiple health problems and years away from Medicare, if I lost my job.

      But I'm funny that way.

      The glibness of the purity brigades never ceases to amaze me.  

      •  Some progressive you are. (2+ / 0-)
        Recommended by:
        Tuffie, BelgianBastard

        Some time, a generation from now, when we get real reform, a US NHS, or perhaps just single payer, we would put your name on a tasteful monument on the Mall in DC.

        It's not like your sacrifice would be in vain or anything. Or that we wouldn't be grateful.

        Where's the team spirit?

        The superfluous goods of the rich are necessary to the poor, and when you possess the superfluous you possess what is not yours." St. Augustine

        by Davis X Machina on Sat Jul 05, 2014 at 03:08:48 PM PDT

        [ Parent ]

      •  I agree with President Obama. (0+ / 0-)

        Up to the autumn of 2009 he insisted that a robust public option was a "bedrock requirement" for reform and he promised in plain English that he would not sign a bill without a public option.

        What a horrible purist asshole he was.  And I guess I'm a horrible purist asshole for continuing to agree with what he said.

    •  because some of us needed health care (3+ / 0-)

      because we fell between the cracks in the employer-based health insurance system, or had pre-existing conditions that made the insurance companies charge us more than our mortgage payment if they'd cover us at all.

      It may be a crappy law -- it's not the one I would have written -- but it's better than not having it.

    •  My shit sandwich saves me a lot (1+ / 0-)
      Recommended by:

      and you will have to pry it from my cold dead hands

      Thanks Democrats! My Obamacare is permanent coverage no one can take away - and saving $3,000 is nice too

      by sotiredofusernames on Sat Jul 05, 2014 at 10:05:24 PM PDT

      [ Parent ]

  •  We Didn't "Skip The Shit Sandwich" Because..... (4+ / 0-)
    Recommended by:
    Tommy Aces, BelgianBastard, hbk, catfood

    of the opposition & obstruction then, during, after & now.

    It has never let up.....not for one single, solitary moment.

    Have you forgotten what it was like?  Have you forgotten Democratic Representatives being spit on & screamed at as they walked to vote for the law against a screaming mob, including Republicans like Michelle Bachmann, stirring up the hatred & the mob mentality?

    It was never a cakewalk.....that's why we didn't get the sandwich we all wanted.....single payer or the Public Option.  

    •  We didn't get single payer (0+ / 0-)

      Because Blue Dogs were saying they couldn't vote for it. Everything bad about the ACA is the fault of Democrats, but, everything good about it is also the triumph of Democrats. All the republicans get is a raspberry.

  •  Anyone know the rationale for narrow networks? (0+ / 0-)

    It's been an issue in New Hampshire, especially because only one insurer offered ACA plans this year.

    The insurer's plans specified a network excluding some 40% of the hospitals in the state.  I can see three reasons why they might do this:

    a) The excluded hospitals charge too much for service (perhaps not for specific operations or diagnostics, but on average - for example, because they see each patient four times instead of three in treating chest pain)

    b) The included hospitals made some sort of special concessions to the insurer - perhaps investing in compatible software, perhaps faster turnaround on bill payment

    c) The excluded hospitals are pretty much the same as the included hospitals - but by  increasing the coverage area of each hospital (by making patients drive further), they achieve economies of scale.

    Anybody know if any of these is the driving force - or if it's something else?

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