The Morning Plum: White House braces for terrible Obamacare enrollment numbers

November 12, 2013

This week, the White House will release the initial tally of the numbers who enrolled in the Obamacare exchanges, and Republicans are preparing to feast on the totals with the abandon of attendees at a Roman banquet.

The tendency of folks to sign up late in the process (which was anticipated), plus the problems that have plagued the website (which were, to put it delicately, not anticipated), have conspired to produce significantly lower numbers than expected. But this debate will also be complicated by another factor: How exactly the administration designates what it means to “enroll.” Sarah Kliff explains:

Health insurance plans only count subscribers as enrolled in a health plan once they’ve submitted a payment. That is when the carrier sends out a member card and begins paying doctor bills.

When the Obama administration releases health law enrollment figures later this week, though, it will use a more expansive definition. It will count people who have purchased a plan as well as  those who have a plan sitting in their online shopping cart but have not yet paid.

“In the data that will be released this week, ‘enrollment’ will measure people who have filled out an application and selected a qualified health plan in the marketplace,” said an administration official, who requested anonymity to frankly describe the methodology.

I’m going to suggest that the White House err on the side of transparency. If possible, we should see the number who have selected a plan, and the number who have purchased one. Given the controversy that justifiably greeted Obama’s false claim that you can keep your plan — in which the failure to be fully forthcoming only played into the hands of those determined to destroy the law — there’s just no percentage in opting for anything that contains the slightest whiff of opacity. Perhaps the White House fully intends to share all it can — as I understand the situation, it may not be logistically feasible to supply the number who have purchased plans. But either way, we should see as much information as possible.

Of course, the flip side here is that even if it proves logistically impossible to share the numbers of those who have purchased a plan, foes of the law will ignore this and allege a cover-up and conspiracy in any case.

According to reports, the initial tally of enrollees — however they are being counted — is in the neighborhood of 40,000, far short of the 500,000 initially projected. The administration has not confirmed this number. That aside, as Jonathan Cohn notes in a good overview, initial enrollment numbers were always going to be low, and what really matters is whether the pattern we saw in Massachusetts — a huge number of late sign-ups towards the end — holds here.

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.

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.

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* LARGE NUMBERS OF MEDICAID SIGNUPS: This, from the Associated Press, will probably get lost in the noise over low enrollment numbers:

The underdog of government health care programs is emerging as the rare early success story of President Barack Obama’s technologically challenged health overhaul.

Often dismissed, Medicaid has signed up 444,000 people in 10 states in the six weeks since open enrollment began, according to Avalere Health, a market analysis firm that compiled data from those states.

And of course, this is in spite of the fact that many GOP governors opted out of the Medicaid expansion.

* WORRIES GROW THAT OBAMACARE WEBSITE WON’T BE FIXED IN TIME: The New York Times reports on major insurance companies that are so worried the Obama administration won’t fix the health law website in time that they are exploring alternate avenues to enroll people, such as direct enrollment and/or calculation of eligibility for subsidies without the federal system. This tidbit seems important:

Kathleen Sebelius, the secretary of Health and Human Services, has promised to have the website’s technical problems largely solved by the end of the month. But inside the White House, there is increasing anxiety that the troubled rollout of the health care site could imperil the remainder of Mr. Obama’s presidency.

Well, that’s bad. But if nothing else, this suggests Congressional Dems are wrong to worry that the White House doesn’t grasp the urgency of the situation.

* OVERWHELMING SUPPORT FOR MINIMUM WAGE HIKE: A new Gallup poll finds 76 percent of Americans, including a majority of Republicans, supports raising the minimum wage to $9. Tying it to inflation is opposed by Republicans, a large majority overall — 69 percent — is in support.

With Dems set to push a minimum wage hike, Senate Republicans are expected to filibuster it and House Republicans would probably not bring it to a vote in any case – aligning them with a position supported by 22 percent of Americans. Dems will run on the minimum wage next year, just as they did in 2006.

* DEMS GIRD FOR BUDGET FIGHT: The Huffington Post has an interesting look at Senator Patty Murray, the Dems’ leader in the coming budget negotiations with Paul Ryan and Republicans. This hard line — no entitlement cuts without new revenues – is the key:

“I look at this as the Republican opportunity to stand up and show there can be adults in their party and help our country find compromise and move us forward as a country,” Murray said…Her iron rule is that Republicans get nothing if they are not willing to give something in the way of raising revenue. And replacing the sequester cannot mean simply boosting defense and cutting domestic programs.

The game plan will be to try to cast any failure to reach a deal, which would lead to more crisis-to-crisis governing, as the result of the GOP’s inability to enter into basic governing compromises — thus using the terrible state of the GOP brand as leverage against Republicans.

*  ELIZABETH WARREN A THREAT TO HILLARY CLINTON: Don’t miss Noam Scheiber’s big, well reported take on all the ways Elizabeth Warren poses a threat to Hillary Clinton’s presidential ambitions as the person best positioned to capture the passion among rank and file Democrats who want the party to shift in a more economically populist direction.

Putting aside whether Warren will even run, this divide in the party over how aggressively it should prioritize Wall Street accountability and the need to combat inequality is key to understanding many of the policy debates of the moment — such as the proposal to expand Social Security — and bears watching.

* REPUBLICANS PLAN NEW ROUND OF FEMALE OUTREACH: Jonathan Martin reports that three female GOP consultants are planning to roll out a new firm whose goal is to improve GOP messaging and outreach among female voters, on the sensible rationale that they represent a majority of the electorate, even as recent elections have showed a widening gender gap:

The three strategists will undertake public opinion research, TV ads and general consulting for Republican candidates about how to better reach that majority.

Okay, but it remains to be seen whether this leads to genuine discussion about whether the party’s actual policies and priorities need an overhaul — something that still has not happened a year after the election.

* BLAME GAME UNDERWAY FOR DEATH OF IMMIGRATION REFORM: The Hill reports that the finger-pointing has started inside both parties over the death of immigration reform this year. The White House reportedly did not want Dems to agree to a more conservative plan being discussed by the House “gang of seven” negotiators. But this seems like the most important factoid:

Speaker John Boehner…refused pleas from GOP negotiators for a commitment to move the House bill. Republicans could never give Democrats a clear sense of how many GOP lawmakers might support the proposal if it ever reached the floor.

So the House GOP leadership would not allow a vote on any comprehensive bill. As always, if immigration reform dies over the long term, it will be because House Republican leaders killed it.

* AND DEMS HEADED FOR SWEEP IN VIRGINIA? The latest tally in the razor close Virginia Attorney General’s race shows the Democrat edging into the slimmest of leads — 117 votes! — with a recount very likely. If Dems manage to sweep all three statewide races in this increasingly blue presidential swing state — one that is seen as a leading indicator of national political and demographic trends — recriminations among Republicans will only intensify.

What else?

Greg Sargent writes The Plum Line blog, a reported opinion blog with a liberal slant -- what you might call “opinionated reporting” from the left.
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Jonathan Bernstein | November 11, 2013