Greg Sargent (his emphasis)
Let’s face it, the spin war over initial low enrollment figures just doesn’t matter that much. Because the story here is the same as it always was: All that matters is whether the policy works in the long run.Yes, and yes. And he's also correct that the best play for the administration is to be as open about the statistics involved as possible.
If it does, then all of the spin of the moment — low enrollment proves the law is in total collapse! Red state Dems are fleeing the wreckage wholesale! — will be forgotten entirely, and Republicans will have to readjust to a political landscape in which the law is working for lots and lots of people. If it doesn’t — if the website doesn’t work in the new year, or if enrollment figures remain too low over time, causing the exchanges to collapse – then all bets will be off anyway.
I'm mostly still sticking with what I said a while ago, which is that ultimately the web site problems won't destroy the program. They certainly could cause a lot of disruption, though; Brian Beutler points out that if it really is impossible to enroll at the same time that current plans are discontinued, then that's an enormous problem mostly separate from all the hype about "keep your plan," and it's a problem with no real obvious solution. Other than, you know, to get the damn program working.
And, yes, as Sarah Kliff says today, what's important is who signs up as much as it is how many.
But regardless: the law is here, it's being implemented, half a million people have signed up for Medicaid, young adults are on their parents' plans, the donut hole is disappearing and other Medicare benefits have begun, lifetime and yearly caps and rescissions are gone...all of that is going to be very, very, difficult to displace. So when Greg says -- and I agree -- what matters is whether ACA works or not, what it matters to is the next wave of reform and change. Repeal? No, we're never going back to the status quo ante.
Spin over first-month signups, meanwhile, won't affect any of that.
Nice catch!
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Your last (analytical) sentence is
ReplyDeleteSpin over first-month signups, meanwhile, won't affect any of that., where "that", of course, refers to "whether the ACA works or not".
Of course, the key input determining long-term viability of the ACA is the willingness of young healthies to sign up. I infer from your last sentence that you believe that negative equity about the ACA will have no impact on the decisions of young healthies wrt the ACA.
I wholeheartedly, though respectfully, disagree.
Fair enough that I don't make the case in this post. I think I did it in an older post somewhere or another...
DeleteMostly, I very much doubt that reporting in the political press about ACA is going to filter down to decisions by most people about getting insurance. Maybe a very minor factor, but that's about it.
Part of which is just that the effects spin are limited by whether the system works or not. If Obama wins the spin war but healthcare.gov doesn't work in March, then people won't sign up, obviously. If Obama loses the spin war over October signups but then the system is in great shape on December 1...well, the positive story there will overwhelm the older bad news to some extent, but it will certainly overwhelm the plausible difference in the conventional wisdom about early problems between good spin and bad.
I guess its partially a question of what defines "reporting by the political press", but when we talk about "young healthies", we mean "young, unsubsidized healthies", which is to say "reasonably well-off millenial hipster-types".
DeleteAnd the variable in question is, "How much will that class of folks embrace Obamacare, which - ymmv - is running away with the prize for 'biggest IT clusterboink in history'"?
I would think that every reminder of the epic IT fail of Obamacare makes it that much harder to get those folks to embrace Obamacare. Let's face it, Obamacare was going to be a difficult sell for those folks, even if it had been wrapped in 'cool' (as opposed to, er, the status quo).
It's a bit more complicated than that. There's a difference between getting the insurance market to work and how much ACA affects the federal budget.
DeleteIf I understand it correctly, the insurance market doesn't care who pays premiums -- it can be the rich (who pay themselves) or the not rich (where it's a combination of the gov't and themselves). All that matters is that some people are paying more in than they receive in benefits.
For the federal government...hmm, actually it shouldn't matter to the deficit whether unsubsidized people sign up or not, right? That's not where the revenues come from.
True. The fail safes will ensure that Obamacare 'works' (at least for a couple of years, regardless of who signs up). But it seems to me that signup of the unsubsidized is crucial for preventing a huge deficit hurt from Obamacare.
DeleteAfter all, if I didn't pay my car or homeowner's insurance premiums in the overwhelming majority of years where I make no claims, the insurance company would have to come up with the money to pay out claims from somewhere, no?
In the case of Obamacare, should there be a paucity of healthy signups, that "somewhere" has to be the already-strained federal budget.
When I hear that "signups" means people who have actually made their first payment for coverage that doesn't begin for two months, my initial reaction is: who in their right minds would pay for something so far in advance if they don't have to?
ReplyDeleteHonestly, I'm not particularly concerned about the low October enrollment numbers....
One thing I don't think anyone is pointing out is that as far as I can tell based on my experiences and those of a number of people I've asked over the past week, the website already works just fine. Obviously they're not going to trumpet that until they're absolutely sure lest it blow up in their face again, and they'd probably prefer right now it have a lower user load anyway, but I think this whole chicken little thing is a big smokescreen designed to lower expectations so in two weeks when there are no noticeable issues it seems miraculous instead of routine.
ReplyDeleteAfraid not -- and not just because I can't manage to get through it myself.
DeleteI suspect -- and this is just a guess, haven't seen any reporting on it -- that it works pretty well now for those with pretty basic situations. Single people, for example. My family situation is hardly complex, but it does have a few twists, and that's where I've been getting caught.