Many in the health policy world see Oct. 1 as a crucial date, when Obamacare's new exchanges open and, for the very first time, millions of uninsured Americans will shop in a completely overhauled insurance market.
Peter Lee sees Oct. 1 a whole lot differently. He is running Covered California, the Obamacare exchange that will serve the country's most populous state with over 7 million people who lack insurance coverage. And he expects that, on Oct. 1, exactly two people will buy coverage.
Not 2 million. Not 2,000. Two Californians, he told reporters when pressed for a projection of Oct. 1 enrollment, would likely sign up.
This was a bit of a joke and not an official California projection. It was, however, meant to underline the very low expectations that health officials have for first-day Obamacare enrollment.
This isn't to say that Lee, and others, expect Obamacare not to work; quite to the contrary, he thinks that by the time open enrollment ends in March, somewhere between 800,000 and 1.3 million Californians will have signed up for coverage through the marketplace. He just doesn't expect a big rush to buy on the very first day of open enrollment.
"We really anticipate very few people going through the full enrollment process in the month of October," Lee says. "What we're pushing for is we want to have as many people sign up who will have their coverage become effective in January."
Given all the emphasis on Oct. 1, why is California projecting such low enrollment? It mostly has to do with when coverage takes effect. Any plan purchased between Oct. 1 and Dec. 15 takes effect on Jan. 1. So there's really not much in the way of an advantage to being the first consumer in the door.
Or, as Rhode Island's exchange head Christine Ferguson put it, "The idea that people are going to do layaway purchasing three months out goes against the American way."
There will certainly be no shortage of stories on what happens Oct. 1, who signs up and who has trouble signing up. But, at least from the view of the people running the marketplaces, Oct. 1 doesn't really matter. It's the rest of the six-month enrollment period when most people will actually get around to buying coverage.