This week, the administration announced that it would “ramp up” its advertising for ObamaCare during NBC’s coverage of the Winter Olympics to encourage younger Americans to purchase health insurance. Late night comedians soon went to work. According to Jimmy Fallon, the administration’s plan “makes sense if you think about it. ObamaCare went downhill fast, left people cold, then somehow managed to skate by….that’s good marketing there….The Olympics are a lot like Obamacare. You know, because they both take around four years to get it together.” After a tough 2013, I’m sure the Obama adminstration was hoping the new year would bring a new policy story.
Time will tell how well the administration will “get it together” in 2014. I’d argue that recent news reports about the number of new enrollees represent an incomplete picture of success. The best measure of ObamaCare’s impact is not how many Americans indicated a desire to sign up for insurance online, over the phone, orin person in recent weeks, but rather how many actually pay premiums to their private insurers to complete the enrollment process. In Rhode Island, the state’s health insurance exchange, Health Source RI, recently extended the deadline for individuals to pay their premiums into the second week of January. This is not an encouraging sign, for it suggests that many individuals who’d signed up may not actually purchase a plan. Rhode Island’s record is significant here, for the state offered an unusually supportive climate for implementing the new law, replete with political support from the governor and a multimedia ad campaign. To date, however, the CEO of Blue Cross and Blue Shield of RI, the state’s largest private insurer (and the only traditional insurer to offer individual policies through the state’s exchange) reported that enrollment remains “disappointing.”
In this end, judgments about ObamaCare can draw an important lesson from the annual college admissions process. Each year, colleges accept many more students than actually enroll. For admissions officers, the most important statistic is the number of accepted students, but rather the “yield” from each applicant pool – that is, how many students actually submit their deposits and pledge to attend their college or university. Until we have a better sense of the “yield” from individuals who enrolled in coverage through the exchanges, we won’t know how many Americans gained coverage. Even that, however, is not a net total, for it’s still unclear how many Americans lost their policies as a result of the administration’s minimum effective coverage regulations, or how many of these individuals were able to purchase new coverage or renew dropped policies. Accurate estimates of how many Americans gained coverage must account for losses in the private insurance market as well. The jury, in other words, is still out.