“Thanks to #Obamacare, more than 500,000 Americans have already signed up for health coverage.”
— tweet from The White House, Nov. 13, 2013

This tweet from the White House is a great example of trying to make lemonade out of lemons. Let’s explain what these numbers mean — and how the administration has shifted its goals. (For the moment, we will not concentrate on an argument made by some Republicans that any gains in enrollment should be weighed against the number of people who have lost their current plan and still need to get new coverage.)

The Facts

The number “500,000” may ring a bell because the Associated Press last month broke the news that an internal memo had predicted that about 500,000 people would sign up for health insurance by Oct. 31. As the article noted, “that was portrayed as a slow start.”

By Dec. 31, the memo said, projected enrollment would reach 3.3 million nationwide.

But on Wednesday, the actual numbers were released. It turned out that only 106,185 had selected a plan by clicking a button on the Web site page, but an undisclosed percentage have not actually paid their first-month premiums. Moreover, three-quarters of that total applied through state-run Web sites; fewer than 27,000 selected a plan in the federal marketplace.

As the tweet graphic indicated, the bulk of that 500,000 figure represented people who have been “determined eligible” for coverage through Medicaid or the child’s health program (CHIP). But as a footnote reveals, in some cases state eligibility may not have been determined yet, making the figure also a bit squishy.

Medicaid expansion was certainly part of the Affordable Care Act, a.k.a. Obamacare, but Medicaid enrollments were not part of the original 500,000-person estimate disclosed by the AP.

According to the most recent Congressional Budget Office estimate, about 8 million people were expected to sign up for Medicaid in the first year of the new law — and 7 million people were expected to receive insurance through the exchanges.

So, another way to look at it, after one month, is that the administration is 5 percent of the way toward the Medicaid projection — and less than 1.5 percent of the way toward the exchange projection.

Before the troubled launch of HealthCare.gov, Health and Human Services Secretary Kathleen Sebelius told NBC News on Sept. 30 that “I think success looks like at least 7 million people having signed up by the end of March 2014.”

But more recently, the administration has distanced itself from that figure.

“That’s a goal that CBO said is what they thought would happen,” White House communications director Dan Pfeiffer said on ABC’s “This Week” on Nov. 3. (CBO does not set “goals,” but it produces estimates that are sometimes embraced by officials as goals.)

Indeed, when the AP story was published, administration officials suggested it was just one way to measure the rate of enrollment. More recently, they have pointed to the experience in Massachusetts, which created the first health-insurance law with an individual mandate. But as we have noted, there are some significant differences between the start-up of the two plans.

In particular, the Massachusetts plan had three distinct phases — automatically enrolling people in a type of Medicaid program, then accepting people with subsidized coverage and finally permitting people with unsubsidized coverage. The entire process took more than a year.

Looking just at the non-Medicaid part of the program, in the first sixth of the enrollment period, the equivalent of one month of the federal enrollment period, Massachusetts had enrolled about 6 percent of total enrollees.

With just 1.5 percent of the anticipated 7 million enrolled, Obamacare thus is 75 percent off that pace.

The final part of the tweet notes that nearly 1 million people have “completed application but haven’t selected a plan yet.” Nearly 700,000 of those people are in the federal exchange, suggesting that the balky Web site has been a serious issue. More than 95 percent of the people in the federal exchange who completed an application have not signed up for a plan, the report says.

The Pinocchio Test

As tweets go, the administration earns some credit for breaking out the raw enrollment numbers — even if the actual accounting appears a bit generous. And perhaps it is just sheer coincidence that the tweet highlights the very figure — 500,000 — that had been widely reported as the administration’s one-month goal.

But happy talk can only go so far. The first month’s enrollment figures are nothing to crow about.

One Pinocchio


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