Obamacare Reaches Its Target. Can We Stop Pretending That Number Matters Now?

Obamacare numbers
Six-month-old Hazel Garcia chews a pamphlet at a health insurance enrollment event in Cudahy, California March 27, 2014. Lucy Nicholson/Reuters

The White House announced Wednesday that more than 6 million Americans have signed up for insurance under the Affordable Care Act, a long-awaited target set by Obama administration, with four days left in the initial enrollment period.

It’s a minor political victory for the president. It’s also a reasonable opportunity for analysts and policy experts on both sides of the political aisle to remind observers how little the figure shows—and to tout the more reasonable metrics of Obamacare’s success that might now come into play.

“It's not really relevant,” Jonathan Gruber, a professor of economics at MIT who advised President Obama on the law, told Newsweek. “The bottom line is this law is most appropriately evaluated over a three-year time frame.”

Gruber also advised Mitt Romney on the former Massachusetts governor’s health care law. “In Massachusetts, we didn’t just pay attention to these minute-to-minute or day-to-day changes,” he said. “It’s crazy how much attention we pay to all these numbers every week or every month.”

So where did 6 million come from? As Obamacare critics are quick to point out, the Congressional Budget Office initially projected that 7 million Americans would sign up during the six-month enrollment period. Following a glitchy rollout, the CBO’s number of expected private insurance sign-ups was reduced to a more modest 6 million.

But that was never the ultimate metric of the act’s success, analysts say. And it risks obscuring other, more valuable data points, some of which won’t be available for months.

Gruber said what matters is that there be enough people enrolled for the exchanges to function, “which appears to be true.” He also pointed to the health mix of people signing up and how many of them were previously uninsured—two figures that won’t be available until late spring or early summer.

He wished he could “press a magic button” that would keep people from assessing the bill’s success until several years have elapsed.

Charles Gaba, a Web site developer in Michigan who has been tracking enrollments on ACASignups.net, concurred that the 6 million figure represents a relatively small indication of the bill’s success.

“We’re only talking about the private, qualified health plans that are sold through the exchange web site,” Gaba stressed. “That does not include Medicaid. It does not include the small number of ‘SHOP’ small business enrollments. And most importantly, that doesn’t include the off-exchange qualified plan enrollments—which I suspect are several million at least.”

Gaba agreed that the ratio of healthy to non-healthy signups carried more weight. “What’s most important long-term is that the uninsured rate goes down overall,” he said. “It’s starting to look like it’s dropping, but it’s going to take a long time to really see a long term trend on that.”

President Obama’s critics from the right have been especially dogged about holding the ACA to its early enrollment projections. But after watching the numbers steadily climb toward 6 million in the past week, they have also been forced to acknowledge that far stronger signifiers of the bill’s success exist—or will exist.

“Every time the administration releases enrollment numbers, they cannot distinguish between those who are actually new customers versus people who had coverage [and] that coverage was canceled,” Joe Antos, a health policy expert at the American Enterprise Institute, a private conservative think tank, said. “If it turns out that of the 5 million or 6 million people you only get a million or maybe a million and a half who truly didn't have insurance last year, that's a public policy failure.”

“The 6 million is a very important number, but it does not guarantee success,” Antos said.

While that number has been reached, enrollment data won’t be available until next month because of an extension for those who have tried unsuccessfully to enroll through the federal marketplace.

So why the continued focus on whether or not 6 million enrollees would sign up by the March 31 deadline? Most obviously, it simplifies a process that is, to most observers, inscrutably complex. It also gives observers data to talk about before there is, in fact, extensive meaningful data to talk about.

“Some of that is an American thing,” Gaba argued. “We like to watch the numbers climb. Everybody likes a horse race.”

But no matter the numbers, this horse race is still ongoing.

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