Supporters, opponents gear up for Obamacare election fight in 2014

More than 1 million Americans have signed up for health insurance under the Affordable Care Act. But problems could lie ahead, and that’s likely to feature in the midterm congressional elections.

Politically battered and at times apparently bewildered over the plight of the Affordable Care Act, the Obama administration is finishing up 2013 accentuating the positive accomplishments of "Obamacare" and hoping to spin that forward into more good news in 2014 – not, incidentally, a year for congressional elections that could change the balance of power on Capitol Hill.

That effort came with the pronouncement Sunday that total enrollment using the website HealthCare.gov had surpassed 1 million Americans, most of those in December after the online sign-up computer bugs had begun to be addressed. Together with the 14 state insurance exchanges, the total is likely more than 1.5 million.

“More than 1.1 million people enrolled in a qualified health plan via the Federally-facilitated Marketplace from October 1 to December 24, with more than 975,000 of those enrolling this month alone,” Centers for Medicare & Medicaid Services (CMS) Administrator Marilyn Tavenner wrote in a blog post Sunday.

“Our HealthCare.gov enrollment nearly doubled in the days before the January 1 coverage deadline [Dec. 24] compared to the first few weeks of the month,” Ms. Tavenner wrote. “December enrollment so far is over 7 times that of October and November. In part, this was because we met our marks on improving HealthCare.gov: the site supported 83,000 concurrent users on December 23rd alone.”

Still, Vermont Democratic former Gov. Howard Dean acknowledged on “Fox News Sunday” that problems are likely to continue with the Affordable Care Act – in particular the balance between younger, healthier people and those older enrollees likely to need more health-care treatment, which could affect the cost of the program.

“The data does show that less healthy people are signing up,” said Mr. Dean, a medical doctor who once headed the Democratic National Committee (DNC). “Younger people are signing up less frequently than hoped.”

The administration had projected more than 3.3 million overall would be enrolled through federal and state exchanges by the end of the year.

The administration has yet to provide a December update on the 14 states running their own exchanges. While California, New York, Washington, Kentucky and Connecticut have performed well, others are still struggling.

A key indicator of whether state-run exchanges are keeping pace with the federal exchange will come next month, when the administration releases full December figures. Overall, the goal is to sign up 7 million Americans before the first-year open enrollment period closes at the end of March.

A few states offering their own updates have posted encouraging totals, including New York, where more than 200,000 have enrolled either through the state exchange or through Medicaid, a government program expanded under President Obama's health law to cover more people. In California, a tally released Friday showed nearly 430,000 have enrolled through the exchange so far.

"They've got the front end of the system working really well," insurance industry consultant Robert Laszewski told Politico. "Now we can move on to the next question: Do people really want to buy this?"

Administration officials are taking the long view.

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

As the midterm congressional elections approach, both sides are gearing up for a fight that will center in a major way on Obamacare.

Americans for Prosperity, a leading tea party group, has begun focusing its 2014 congressional campaigning on an effort to defeat incumbent House Democrats who support (or at least don’t sufficiently oppose) Obamacare.

“Obamacare is a reality," Rep. Darryl Issa (R) of California acknowledged on “Meet the Press” Sunday. “Unfortunately, it is a failed program that is taking a less-than-perfect health-care system from the standpoint of cost and making it worse. So the damage that Obamacare has already done … will have to be dealt with as part of any reform.”

Meanwhile, according to a Politico piece Sunday, “The White House, Democratic lawmakers, and advocacy organizations will launch a campaign this week to highlight real-life experiences under the Affordable Care Act – tales so compelling that they help drive up enrollment, marginalize Republican repeal efforts and erase memories of this fall’s HealthCare.gov debacle.”

“Sharing experiences neighbor to neighbor is often the most powerful way to spread awareness,” White House communications director Jennifer Palmieri told the online news site. “This effort will help give Americans the chance to speak firsthand about being able to buy quality, affordable insurance because of the Affordable Care Act. And in the coming weeks and months, as more Americans buy insurance and see their coverage kick in, we will continue to find opportunities to help share their experiences.”

This report includes material from the Associated Press.