November 13, 2013
HHS Secretary Kathleen Sebelius (AP Photo/David Tulis)
HHS Secretary Kathleen Sebelius (AP Photo/David Tulis)

The enrollment numbers are in, and as expected, they are well short of projections. Around 106,000 enrolled in new plans during October — with approximately 27,000 coming from states where the federal government is running the exchange (with its extensive problems), and another 79,000 coming through the state exchanges. Republicans are gleefully pointing to the numbers as proof Obamacare needs to be scrapped entirely.

That confirms two things we’ve long known to be true: the website is a disaster, and short term enrollment figures are a serious political problem for the White House and Democrats. But to Larry Levitt, a vice president at the nonpartisan Kaiser Family Foundation, another very telling number is this one: over 975,000 have been determined eligible for a marketplace but haven’t yet chosen a plan.

“That’s one of the most telling numbers — a million people have been determined eligible,” Levitt tells me. “That means if the website had been working well, and a million people had gotten to the end of the process, we’d be looking at a very different trajectory now. We heard about the surge in traffic when HealthCare.gov went live. This suggests there is in fact a lot of interest.”

The thing is, though, that even this one-million number highlights both the perils and the potential upsides in not getting the damn website fixed. It shows us that if it isn’t fixed demand isn’t going to matter at all — enrollment will be very low, regardless of demand, putting Obamacare’s long term prospects in peril. But if it does get fixed, of course, you could see a real enrollment spike.

“Assuming the website gets fixed, I would assume a surge of enrollment in December, and another surge in March,” Levitt tells me.

Meanwhile, the 100,000 number is getting a lot of attention, but the report also finds nearly 400,000 were determined eligible for Medicaid. “In total that’s over 500,000 people who signed up for insurance in the midst of a tumultuous launch,” Levitt says. “People make a distinction between the marketplace and Medicaid, but those are both elements of the Affordable Care Act — both are mechanisms to get people insured.”

In one sense what we’re really seeing in these numbers is the first concrete representation of what the de facto GOP health care plan — repeal Obamacare and replace it with nothing, since there’s no GOP consensus on a replacement – looks like. Presuming many of the 106,000 do pay in the end, GOP repeal would entail taking health coverage away from hundreds of thousands of people.

Republicans will argue that as it stands now, many more people are feeling an adverse effect from Obamacare — by losing coverage or seeing higher premiums. That is a very valid point. But the crux of the issue is that the question of how many will benefit, and how many will be adversely impacted, is far from settled. We don’t know how many people will sign up, and we don’t know how many people will really be adversely impacted, since many may find plans on the exchanges they like better – many may find those plans provide a better deal in the long run or that subsidies keep their prices low.

Indeed, if it’s true that today’s numbers show demand is high — and if the website does get fixed – GOP smugness about the collapse of Obamacare may look awfully shortsighted in a few months. As bad as today’s numbers may have been — and allowing that the law’s success over time is anything but assured — Obamacare is moving forward, and we have a glimpse of what that really looks like.

Levitt puts it simply: “We’ve heard all about the negatives of the Affordable Care Act. This is the first tangible sign of what the ACA set out to do, which is to cover people.”

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