The Health Equity Blog’s mission is to contribute to the discussion of health policy using evidence and research, to explore the opportunities for health equity through policy change, to raise awareness about health disparities, and to increase public advocacy for health equality.

According to the CDC, “Health equity is achieved when every person has the opportunity to ‘attain his or her full health potential’ and no one is ‘disadvantaged from achieving this potential because of social position or other socially determined circumstances.’”

Achievement of full health potential is necessary in all aspects of life – from running errands to relationships with loved ones. Some people are born into environments that limit their ability to achieve their full health potential. We believe that because society created many health inequalities, society can also fix them.

Monday, October 21, 2013

21 Days of ACA Insurance Enrollment

October 1st was the big kickoff day for the Insurance Exchange Marketplaces, one of the fundamental components of the Affordable Care Act. Using the marketplaces, Obama administration is to sign up 7 million people by March 31, 2014. That’s pretty ambitious, considering many uninsured people are unfamiliar with the Affordable Care Act or even health insurance in general. To help with outreach and enrollment, the administration distributed grants to organizations to hire navigators, in-person counselors, and certified application counselors. Despite the different names, the job titles have the same goals - ENROLL, ENROLL, ENROLL. Many people are interested in labeling ObamaCare - Is it a success? Is it a failure? Is it way too soon to say? Well, like most highly political policy implementations, it depends on who you ask.

What people who believe ObamaCare is failing are saying
  • Low enrollment numbers. In the first three weeks at least 115,000 people enrolled in state-based Marketplaces. The exact number has not been released by the administration (look for that number to be available in November), so this is an estimate based on what the states are reporting. At that rate by March 31, 2014, fewer than 3 million people will be enrolled in the marketplace. Three million enrollments is significantly less than the Obama administration’s 7 million goal. Among those who have visited healthcare.gov to look at insurance options, 99% have not actually enrolled. 
  • Technology problems have forced people away. At this point, ObamaCare supporters and ObamaCare opponents agree on one thing - there are technology problems. Healthcare.gov, the website for 34 federally facilitated and federal/state partnership insurance exchanges, has been unusable by most accounts. In reference to healthcare.gov, even President Obama said in an interview, ‘The website that was supposed to do this all in a seamless way has had way more glitches than I think are acceptable.” Below are responses from the survey detailing the problems people had logging into marketplace.gov. As you can see, of those surveyed, only 1 in 5 did not encounter any problems. Technical problems in the short term may lead to enrollment issues in the long term if people get so discouraged they stop trying and pay the fine for being uninsured.

What people who believe ObamaCare is succeeding are saying
  • Enormous Healthcare.gov website activity. On October 1st, over two million people visited healthcare.gov. The two million people does not include citizens of states that run their own insurance marketplaces. That means that Americans are interested. The call center was jammed and community organizations were swamped with questions. Individuals have until December 15th to enroll in insurance for coverage to begin January 1st. As soon as the website bugs work themselves out, Americans will be enrolling. Below are the results of a survey from CNBC that asked those who had problems enrolling in an Insurance Marketplace  what they planned to do next. As you can see, a majority said they will continue to try and only 2% say they have given up trying to sign up.

  • Insurance enrollment in non-federally facilitated exchanges. Some states opted to run their own web-based insurance marketplaces and thus did not work through the federally managed website healthcare.gov. In these states, people have been able to successfully enroll. Below is a summary of four states that was released by the Obama administration on October 18th. Minnesota also released information that 11,684 people completed applications for coverage in the first two weeks. Although these states also had initial technology problems, many Americans have signed up for health insurance through their exchanges. Again, Americans are interested in insurance.

ObamaCare: a success or failure? Waaaaaaay too early to tell!
Healthcare.gov is frustrating. I work at a health center with a grant to enroll people in insurance. We are having a hard time doing our job since I work in Illinois (a state partnering with the federal government) and are stymied by the technical problems of healthcare.gov.

Technology malfunctions do not make ObamaCare a failure. However, ObamaCare is not a success because people jammed the website with activity. I urge people to be patient and remember no one will get coverage before January 1st anyway.

Am I excusing the government? Not at all - our government mishandled the roll out of the exchanges. Implementation of the Affordable Care Act will be messy. But website hits and enrollment numbers do not tell the entire story. The real test will be whether the Affordable Care Act proves the idea that health insurance equals better health.

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