Obamacare enrollment surge: Mission accomplished or misleading blip?

HealthCare.gov handled a December surge in Obamacare sign-ups with apparent aplomb, according to administration officials. More than 975,000 Americans enrolled in private insurance plans through the federal health-care marketplace during the month, bringing the total since Oct. 1 to 1.1 million enrollees.

Tech fixes to the front end of HealthCare.gov appear to have worked, wrote Marilyn Tavenner, administrator of the Centers for Medicare & Medicaid Services, on her official blog. On Dec. 23 alone, the site supported 83,000 simultaneous users without crashing.

“We are in the middle of a sustained, six-month open enrollment period [and] we expect to see enrollment ramp up over time, much like other historic implementation efforts we’ve seen in Massachusetts and Medicare Part D,” Ms. Tavenner writes.

In addition, roughly 850,000 people have signed up for coverage through state-run Affordable Care Act (ACA) exchanges, according to private estimates. That puts Obamacare’s total enrollment near 2 million. This figure is within shouting distance of the administration’s original estimate of 3.3 million enrollees before Jan. 1.

Woo-hoo! Mission accomplished, right? Is it time for the president to stand in front of a banner in the White House press room and declare victory?

Not so fast, and no, it isn’t time. Even Obamacare’s supporters acknowledge there’s still a long way to go before the effort can be judged a success – or failure.

“It’s premature to say Obamacare is meeting expectations,” Jonathan Cohn writes in The New Republic.

First of all, it’s not clear how many of the new enrollees previously had individual health-care policies canceled because they didn’t meet ACA standards.

Some 4 million people lost health coverage due to cancellation, according to Associated Press coverage. The Obama administration reversed course and said these substandard plans could exist for another year, but not all states and insurers agreed to this fix.

That means it’s possible the United States is entering the first year of Obamacare with a net loss of 2 million insured, according to the law’s critics.

“We’re still ending 2013 with more people having lost their insurance than gained it,” Jim Geraghty writes in the right-leaning National Review.

Second, the ACA will need to see a continuing surge in applicants to meet its overall first-year goal.

While December was big, 2013 enrollment was still more than 1 million short, and the enrollment surge probably won’t continue in January and February. That’s because of the ACA’s multiple deadlines.

Enrollees had to sign up in December to have coverage on Jan. 1. The next important date is March 31, when open enrollment for 2014 ends. After that, individuals without health coverage who are not exempt from Obamacare will have to pay a tax penalty.

If past experience with the implementation of health laws is any guide, the next surge won’t come until the last few weeks of March as possible tax penalties loom.

“These next three months will be pretty important for seeing whether the law hits the Congressional Budget Office projection of 7 million enrollees in 2014 – or, as it has in the first three months of enrollment, continues to fall short,” writes Sarah Kliff, Washington Post health-care expert.

Finally, now the hard part starts. Beginning Jan. 1, people who have enrolled in health plans through federal and state ACA exchanges will begin showing up at doctor's offices and hospital emergency rooms. Not all have received insurance cards yet. Not all have had their enrollment information passed to insurance companies. Glitches in this back end of the system could have an enormous effect on popular perception of the law.

“The front-end of the site is now finally working quite well – in contrast to the very serious back-end issues that still remain,” writes Robert Laszewski, a respected insurance industry consultant, on his blog.

So bottom line: The December surge is certainly a welcome development for hard-pressed administration officials. But they will still be anxious over the ACA’s progress for months to come.