November 12, 2013

In 6 weeks, only 40,000 have signed up through Healthcare.gov — if "signing up" means putting a plan in your "shopping cart."

"That amount is a tiny fraction of the total projected enrollment for the 36 states where the federal government is running the online health-care exchange, indicating the slow start to the president’s initiative."

Though the number is inflated with those who haven't actually purchased a plan, it's not not additionally puffed up with those who signed up for Medicaid. That number is said to be 440,000, which means only 8.3% of those who have managed to use the website are actually buying health insurance, and 91.6% have used it to access a welfare program.
A spokesman for the insurance industry’s main trade group said the slow early enrollment does not matter as much as how many sign up by the spring. “That’s what will determine how well these reforms are going to work,” said Robert Zirkelbach, spokesman for the group America’s Health Insurance Plans.

The insurance industry has a substantial stake in who enrolls, as well as how many do so. Unless enough young, healthy Americans sign up, the cost of coverage is likely to escalate — in turn, discouraging people from getting or keeping coverage.
So the number — 40,000 — is dismal, but if it turns out these are disproportionally the sort of person who will be using a lot of health care services — and don't you think they are? — that's an even bigger problem.

By the way, what's with "young, healthy"? I understand "healthy," but why "young"? If we're going to use stereotypes and generalizations about the groups of people who are less likely to incur health-care costs, why stop at "young"? Why not say "Unless enough young, healthy, male Americans sign up"?

68 comments:

The Drill SGT said...

The exchange is not likely to be fixed any time soon. Certainly not in time to let people enroll by Dec 15. That means all those individual market folks that got canceled will have to buy their insurance (effective Jan 1) on the open market, directly from firms. This will not only drive the 'sticker shock stories" but also the 'I went to the hospital, but my insurance was no longer good' stories.

On top of that, how many of those 40,000 folks and the people that follow them, think right now that they have coverage. same with those whose apps were mangled at the back end EDI transaction. Gonna be stories of dropped coverage there as well.

And of course the narrow network, "mom lost her oncologist and died stories"

The press, even though they are liberal, can't help but love these human interest tragedies for the local news every night.

won't be a pleasant Spring for Dem Congresspersons.

tim in vermont said...

They found a way to put a tax on good health, just haven't worked out a way to collect it.

rehajm said...

The adverse selection begins!- Eeeexcelent! (strokes cat)

The Drill SGT said...

enough young, healthy, male Americans

ssssh...

It's the GOP who declared war on Women... Not the Dems on Men...

Henry said...

This seems to be a wonderful opportunity for a pivot. Delay all the private insurance regulations for a year (or ten) and target healthcare.gov SOLELY on Medicaid signup.

If liberals want to help poor people -- as opposed to yank non-poor people around on legal whip cords -- they should welcome this opportunity.

Finally, the government has build an Internet service that helps the truly poor navigate the complexities of signing up for Medicaid. Claim the win, Mr. Obama, and surrender.

Kevin said...

This is all working as intended. The goal of the system is not to provide a usable health insurance system but to allow them to say "we tried it the compromise way and it didn't work because of the greed of the insurance companies, big pharma, etc.," then the only thing left that could promise to resolve the mess left behind is a 100% government run health care system.

tim in vermont said...

The other western democracies that have some kind of universal medical expense insurance also have much more regressive tax codes than has the United States, which has the most progressive tax code of the bunch. That is why they have the money to do this. They use a VAT.

The Drill SGT said...

Senator Shaheen (D-NH) is going to be an early canary in this. I understand that in most or all of NH, only two firms are offering coverage. One, BCBS has 70+% share. Of the 26 acute care hospitals in the state, only 16 are on at least one of the plans... That is a lot of docs who will be out of plan come Jan.

If that pattern continues into the group policies, it would destroy the state hospital system.

so much for improving health care for all Americans...

PB Reader said...

Another clear example of government failure - unwillingness to operate to the same standards of business. If a CEO insisted on booking as revenue items customers put in their shopping carts but haven't purchased, he would be brought up on fraud charges. If he misrepresented the product on TV like Obama has, he would be arrested and tried like Kevin Trudeau (another Chicago guy).

The Drill SGT said...

Henry said...
This seems to be a wonderful opportunity for a pivot. Delay all the private insurance regulations for a year (or ten) and target healthcare.gov SOLELY on Medicaid signup


In theory fine, but what policies?

Insurance is approved at the state level after a 6 month cycle. (2015 policy cycle starts in a few months) The only policies approved for sale in 2014 are the Obamacare compliant ones with the high prices. without the exchanges and subsidies, those rates are explosive. But of course the subsidies cant happen outside of the non-working (state?) exchanges.

Go back to last years policies? Not approved. and the insurance firm computer systems have been rewritten. At this point, there will be millions of previously insured, without coverage in January...

Curious George said...
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Curious George said...
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Brando said...

I'm not so sure that I buy the argument that this whole mess is part of a plan to get the whole country to adopt single payer health care. If (when) Obamacare fails completely, why would that make Americans more likely to embrace government run health coverage?

My prediction is for a more "back to the drawing board" sort of reform, perhaps a dual system offering subsidized bare bones coverage via a government chartered plan for those who cannot or choose not to get private coverage. That doesn't help much for those who are going to be squeezed while the Administration continues rearranging deck chairs on the HMS Obamacare, sadly.

Carol said...

more regressive tax codes than has the United States, which has the most progressive tax code of the bunch.

I think you mean it the other way around. If they have VAT then it's progressive.

RecChief said...

@Brando-
I think the leftists believed (I used that word intentionally) that by first destroying the insurance industry, things would get so bad that the population would cry out for the federal government to do something about it. Let's face it, with Big Media in their corner, the Democrat party hasn't been held accountable since the Clinton administration, and not very much then, Lanny Davis' assertions to the contrary. In this case, I think they miscalculated. They own it.

Oso Negro said...

It's a government program disaster! And to think, just ONE short month ago, the coolest President evah could have bought himself an additional year to work out the kinks, AND blamed the delay on Tea Party Extremists!

Ha ha ha
Ho ho ho
and a couple of ladee dahs!
It's how we work the day away
In the merry old land of Oz.

tim in vermont said...

Progressive, regressive, a VAT gets more money from the middle class and down, where the big money is.

Henry said...

The Drill SGT wrote: In theory fine, but what policies?

I don't think there's any way around the fact that this year's open enrollment is hosed. Even if the signup was working, the self-insurance market has been gutted by vandals. The copper pipes have been ripped out of the walls, the windows are smashed, and the basement is flooded with sewage.

The task this year is to cobble together a semi-functional market while Congress rolls back the regulations for next year.

It won't happen.

But every time a Democratic Party functionary comes up with an excuse or a scapegoat or a wallpaper cover-up for the wreckage in front of us my answer is simple: you had an opportunity to make Medicaid better, to provide healthcare for the poor, and you refused to do it.

Hagar said...

I think the vast majority of those who have braved the exchange website(s) so far, are those who have received cancellation notices for their present policies, have known medical problems, and are very worried about losing their coverage, even for a short time.

The uninsured are still mainly unaware except perhaps hazily thinking they have heard that the government is going to provide them "free" medical services starting sometime next year, or whenever. They certainly have no intention of paying premiums, and steep premiums at that, themselves.

This venture of the Democrat left wing is not going to end well.

Hagar said...

@Carol,
That's a differnt meaning of "progressive."

MattL said...

McCardle had an article yesterday touching on why simply doing a regulation reset now isn't a solution. Short version: the companies have already moved on and couldn't easily go back.

Of course, if there had been a delay compromise, Obama could have plausibly laid blame for the regulation snafu about rolling stuff back on the Republicans. But now that Dem Senators are asking for it, that will be a difficult sell, even for our media.

Maybe Putin or the French are his best hope here...

Hagar said...

They fired the starting gun, and the snow has started to move up above. It's a-coming on down now whether they change their minds or not.

The Godfather said...

Right, Prof. Althouse, for Obamacare to work, they need young, healthy males to sign up, just the ones who have previously chosen not to buy health insurance, or to buy only very limited coverage, and just the ones who are most overcharged by the premiums required by Obamacare. They figure they can rope in the young women to buy insurance to get the free birth control pills, but what's the incentive for the dudes? I'm sure the brilliant minds that designed this thing thought about that and have an answer; I just can't figure out what it is.

Peter said...

"Why not say "Unless enough young, healthy, male Americans sign up"?

But if you did, you'd have to consider the actuarial effect of sex (and race!) on many other government programs.

For example, consider that life expectancy in the USA is 71.8 years for black men but 81.1 years for white women. And then consider that black men are taxed at the same rate for Social Security, even though the actuarial value of the benefit is significantly higher for white women (because they will use it for more years).

Who thought that Social Security was really a program to transfer money from black men to white women?

(BTW the very first Social Security recipient, Ida May Fuller, lived to be over 100. Over her life she paid $44. in Social Security taxes and collected $20,993. in benefits.)

Marshal said...

The path that minimizes the current mess is eliminating the requirement to use the exchange to get subsidies. Once that's eliminated the insurance companies can sell the policies directly. They (a) already have functional enrollment processes, and (b) are used to reacting quickly, and (c) there are enough of them to expect significant capacity increases.

It still won't be enough capacity, but if the administration waits for the exchange to be ready there will be millions uninsured on 1-1.

betamax3000 said...

I Have the Feeling That the Failure of Obamacare is Rapidly Bringing Obama to His Queeg Moment: We Must Have Taken His Strawberries.

The Drill SGT said...

"but what's the incentive for the dudes?"

"young women with free birth control pills?"

The Drill SGT said...

Marshal said...
It still won't be enough capacity, but if the administration waits for the exchange to be ready there will be millions uninsured on 1-1.


At this point, and ignoring the Medicaid giveaway trap, there will be fewer people insured privately in America on 1/2014 than 1/2013

fewer people insured privately in America on 1/2015 than 1/2014

rinse and repeat...

Heck of a Job Obammie

madAsHell said...

Astroturf?

rhhardin said...

Spring ahead, fall back.

Jane said...

If Pelosi-ReidCare had been designed to allow for actuarial pricing of policies, it wouldn't matter whether all the uninsured healthy young men were signing up because the system wouldn't be dependent on their subsidizing the old, the sick, and women. Of course, it would have required greater government subsidies for these costlier groups, exactly what Pelosi/Reid wanted to avoid with their claims that it's practically free.

Fun fact: the Double X pundits (and apparently many others) don't seem to understand how insurance works in the first place, imagining that it's all about everyone sharing costs with each other and singing kum-bay-yah.

http://janetheactuary.blogspot.com/2013/11/what-part-of-term-insurance-do-you-not.html

Drago said...

MattL:"Obama could have plausibly laid blame for the regulation snafu about rolling stuff back on the Republicans. But now that Dem Senators are asking for it, that will be a difficult sell, even for our media."

LOL

MattL, come on now.

The dems are already blaming the republicans and will continue to do so and the media will continue to parrot whatever claims they make.

The media has already gone all in on obama and the leftist dream and there is simply no way they can go back.

MattL said...

Drago,

Of course, they're going to try to blame Republicans. It's just not going to work as well, except among the lowest of the LIVs and the hard core partisans (i.e., those who are totally immune to facts or reason). I (admittedly) hope.

2014 should be exciting.

tim in vermont said...

Democrats get the "responsibility," Republicans get the "blame."

That's how it works.

Original Mike said...

"So the number — 40,000 — is dismal, but if it turns out these are disproportionally the sort of person who will be using a lot of health care services — and don't you think they are? — that's an even bigger problem."

No, I have no reason to think they are. But in any case, you're going to force them to sign up at gun point? (If you're a supporter of ObamaCare, your answer is "yes", of course.)

Hagar said...

Not mentione above, but it is also said that a very large proportion of the "shopping cart" applications have bad or scrambled information in them, and the insurance companies receiving them have a hell of a time getting back to the applicants to get the applications corrected and properly filled out so that they can be acted upon.

Now, if the number of applications cascade by a factor of magnitude or more after New Years as the administration hopes ......

Scott M said...

By the way, what's with "young, healthy"? I understand "healthy," but why "young"?

If for nothing else than the healing factor, the much-reduced time needed to recover from an injury. Hell, I knew I wasn't bulletproof in my late teens and early twenties, but I damned well could stab myself repeated in the torso with a twelve inch knife and watch the wounds close up in the mirror.

Not even any scar tissue.

Scott M said...

This is all working as intended. The goal of the system is not to provide a usable health insurance system but to allow them to say "we tried it the compromise way and it didn't work because of the greed of the insurance companies, big pharma, etc.," then the only thing left that could promise to resolve the mess left behind is a 100% government run health care system.

That may be, but even if it is, the evilness is being handle incompetently. The insurance companies are standing back, just as flummoxed as the rest of us. Okay, maybe a tad less...but still.

alan markus said...

@ MattL

2014 should be exciting.

I think this makes 2016 exciting:

Bill Clinton: 'President Should Honor the Commitment' and Let People Keep Their Insurance Plans

tim in vermont said...

The problem with single-payer is the same as it has always been. The tort lawyers, huge Democrat donors, will never stand for it.

tim in vermont said...

Can you imagine a single payer system where there is no limit to the funds that get drained off to tort lawyers succeeding?

cubanbob said...

So the number — 40,000 — is dismal, but if it turns out these are disproportionally the sort of person who will be using a lot of health care services — and don't you think they are? — that's an even bigger problem."

Seriously, did anyone with two working neurons expect anything different? What's amazing is the ability of people to suspend common sense when they desire something that logically cannot work. Unless the tax penalty was close enough or greater than the premium-tax this thing had no chance of "working". I suspect the Democrats knew this all along but figured they could raise the penalties later as a correction. What apparently they didn't count on is the massive hostility to ObamaCare on the part of the public, hostility that hasn't diminished and is likely to increase as the cancellations increase and the deadlines come closer.

Marshal said...

I suspect the Democrats knew this all along but figured they could raise the penalties later as a correction

Penalty increases were passed as part of the original bill. The $95talking point is really $95 or 1% of your income, whichever is higher, up to 3X the min.

2014 95 - 285, 1% of income
2015 325 - 975, 2% of income
2016 695 - 2085, 2.5% of income

After 2016 the penalties are indexed to inflation.

n.n said...

Obamacare is a revenue generation scheme. It, along with trillion dollar deficits, is designed to delay accountability. In the worst case, it serves to obfuscate a stagnant or recessive economy.

cubanbob said...

@ Marshall, nice but no cigar. The penalty rates would have to be substantially higher for it to work. A 30 year old earning $30, 000 given a choice between paying $650 in penalties or paying $1,500 for a high deductible plan will most likely pay the penalty. The penalty would have to be at least 5% to really motivate the young and healthy. That and removing the restrictions on the IRS to collect the penalties. If the Democrats recapture the House next year, keep the Senate next year and win in 2016 expect this to be the solution they will impose.

Original Mike said...

"So the number — 40,000 — is dismal, but if it turns out these are disproportionally the sort of person who will be using a lot of health care services — and don't you think they are? — that's an even bigger problem."

I misread this in my 9:57 comment. My apologies.

EMD said...

Not even any scar tissue.

You're Wolverine!

MadisonMan said...

allow them to say "we tried it the compromise way and it didn't work because of the greed of the insurance companies, big pharma, etc.


I don't think so. I think every single American with a functioning brain knows what a clusterf*ck the system is, and the system is not the fault of Big Pharma/Insurance.

damikesc said...

Delay all the private insurance regulations for a year (or ten) and target healthcare.gov SOLELY on Medicaid signup.

...only if a sunset provision is included. Force them to approve this abortion of a bill every 4 years in August before an election.

MattL said...

MadisonMan said, "...every single American with a functioning brain..."

How many of those do you suppose there are? More or less than have enrolled so far?

More to the point, how many who previously voted Democrat and thus helped get us into this mess?

Bob Boyd said...

How many of the 40,000 are Obamacare Navigators? Aren't there supposed to be something like 50,000 Navigators? Are they required to be signed up or do they get a waiver?

Henry said...

MadisonMan wrote: I don't think so. I think every single American with a functioning brain knows what a clusterf*ck the system is, and the system is not the fault of Big Pharma/Insurance.

I heard two guys on the subway today talking about the rollout problems and the one guy said, "of course you had the Republicans adding all sorts of complications to it". Really.

Then they effortlessly segued to a discussion on how dangerous the tea party was.

These guys had functioning brains. It takes a lot of brain power to rationalize so effortlessly.

What's going to hurt the Democrats is all the people who aren't paying attention. People who are told to do something and they do it and it goes all wrong. They won't know why it went all wrong, but they'll know who told them to do it.

Original Mike said...

" I think every single American with a functioning brain knows what a clusterf*ck the system is"

As Adlai Stevenson said: That's not enough.

jr565 said...

Brando wrote:
If (when) Obamacare fails completely, why would that make Americans more likely to embrace government run health coverage?

Because the dems are counting on their low information voters not holding them to account for the problems that they cause.
It's worked pretty well for them so far. It was the rich fat cats fault!

SteveR said...

The system has failed because Republicans wouldn't work with the President. The obvious solution is to re-establish Democrat majorities in both houses and elect Hillary president in 2016. The solution being to stop the war on women, minorities and the poor and go to a single payer (free!!!!!) system. This is so obvious.

hombre said...

If I have an item in my cart at Amazon it is not a "purchase", nor have I "signed up" for it until I actually buy and pay for it.

It is truly unfortunate that the "transparent" Administration has to dissemble about everything and more so that there are dupes who buy into all of it.

I know Obama likes to compare himself to Lincoln who said, "You can fool some of the people all of the time." However, I don't believe Lincoln meant this as a model for Presidential behavior.

S said...

@Marshall, who said "The path that minimizes the current mess is eliminating the requirement to use the exchange to get subsidies. Once that's eliminated the insurance companies can sell the policies directly. They (a) already have functional enrollment processes, and (b) are used to reacting quickly, and (c) there are enough of them to expect significant capacity increases."

A few problems, the biggest of which is that the part of the system (it's not just a website, remember?) that figures out the subsidies isn't working. Besides not working, it's also not connected so the insurance companies can't use it. Besides not working and not being connected, it's a crapshoot anyway (the self-employed have to guesstimate next year's salary -- good luck! -- and will face penalties if their estimate results in underpaying). And a few other things.

Without the subsidies, Hello, Sticker Shock!

Now, the insurance companies are suggesting they'll just estimate the subsidies per info consumers provide (what could possibly go wrong?). Out of the goodness of their hearts? Why, no. They'll do it as long as they get paid with our tax dollars for any underpayments, and get to keep all of the overpayments.

Gosh, wouldn't it be a surprise if their "estimates" ended up maximizing their profits!

The White House is considering this option.

Spectacular failure of Obamacare needs to come fast and hard, before the self-appointed smartest guys in the room cripple our economy back to the stone age.

S said...
This comment has been removed by the author.
S said...

Megan McArdle for more detail/info in the comment above:
http://bloom.bg/HPHzJN

eric said...

It's times like this I miss Ronald Reagan.

I saw Sarah Palin the other day and the host asked her what the Republican plan is to fix this. Her answer should have been, "We're not doctors, we're politicians. Our plan is simple, get out of healthcare and let the free market decide."

It's time for government to stop trying to fix the problems government creates. So annoying.

damikesc said...

Without this laughable attempt to massage numbers -- how many people ACTUALLY signed up for Obamacare?

I mean numbers that wouldn't be subject to a false statement suit if uttered by private enterprise.

Remember that, big government supporters. Private companies cannot lie with impunity the way government can.

And does.

Routinely.

Marshal said...

S said...
A few problems, the biggest of which is that the part of the system (it's not just a website, remember?) that figures out the subsidies isn't working.


This is true, because it's trying to connect to multiple databases and deliver the perfect number. So it'll have to be estimated. The subsidies are based on plan year income anyway with a refund or balance due submitted with the tax return. The new estimate method will have a wider range of error. That's a cost, but not a huge one compared to the alternative: millions of people losing their insurance over this.

They'll do it as long as they get paid with our tax dollars for any underpayments, and get to keep all of the overpayments.

So we tell them no.

At this point there is no perfect or even good solution. Even straight repeal doesn't work because the policies people had are no longer approved by state insurance regulators. So the result of repeal is Obamacare prices without subsidies.

When the naive idealists are discredited for the 18th time on 12-1 this is the least bad conclusion the practical people will agree on.

tim in vermont said...

Let's see, the same guy who cut his teeth as a community organizer occupying branches of banks 'til they dropped their racist requirements to get mortgages that eventually led to the crisis, by yes, many twists and turns, of 2008 now is in the process of destroying the health insurance industry. Whodathunkit.

gregq said...

Henry said...
If liberals want to help poor people -- as opposed to yank non-poor people around on legal whip cords -- they should welcome this opportunity.

Silly man! Democrats want to control you, and they think having complete control over your heal care is a good way to start. It's not about helping people, it's about turning people into permanent Democrat voters.

Hammond X Gritzkofe said...

Proceeding as I predicted.

..The Afraudable Care Act has thrust the health insurance industry into chaos.

..Simply cancelling AFA would prolong the chaos.

..The corrective action taken will be:
....everyone added to the Medicaid rolls gets to keep their free or subsidized program;
....everyone who would have had to buy an expensive policy (or pay a tax) to fund the free and subsidized policies will get expanded coverage at no more than their pre-AFA cost.

..Net result - massive new entitlements, no expectation of funding.

Natalya Kennedy said...

"Democrats get the "responsibility," Republicans get the "blame.""

Absolutely right!

moistwilly said...

Where's Inga? Must have dropped her pom poms

S said...

I said:
They'll do it as long as they get paid with our tax dollars for any underpayments, and get to keep all of the overpayments.

Marshal replied:
So we tell them no.

As I understand it, it's baked into the law. And it won't be "we" telling them -- this is another WH special interest side deal.

Defund or repeal are the only sane options. Maybe not feasible, but I'm a fan of sanity nonetheless :)