Why Extend the Open Enrollment?

Megan McArdle proposes three reasons for the administration’s extension of the open enrollment period for the healthcare exchanges under the PPACA:

One is that the administration fears the system will crash under the kind of demand spike they saw in the last weeks of December enrollment. This is just a prophylactic measure designed to make sure that people who genuinely tried to sign up but couldn’t get through don’t get hit by the individual mandate — and show up on television, crying, shortly thereafter.

The second is that the administration knows, or strongly suspects, that most of the people who have so far bought insurance are people who already had insurance. They’re concerned that when enrollment is closed, they’re only going to be able to point to a net reduction of a few million uninsured — and that almost all the reduction will come from people on Medicaid. So they’re hoping to get a few hundred thousand or million more uninsured people to sign up during the grace period.

The third, most worrying, possibility is that the demographics haven’t really improved substantially. A lot of commentators, including me, have been expecting the “Young Invincibles” — the younger, healthier customers whose premiums will subsidize care for the previously uninsurable — to show up on the exchanges this month. So far, only 25 percent of total signups have come from young adults. And even that may overstate things, because it isn’t unreasonable to assume that the folks who selected plans but didn’t pay for them are young and irresponsible people like … well, like me at 25.

I’ll propose another. Either the administration doesn’t understand or doesn’t believe in insurance. You can’t run an insurance plan the way the administration seems to want to. There’s no way to project your costs which means there’s no way to determine premiums.

17 comments… add one

  • ...

    The only reason THIS Administration would delay the implementation of another deadline is because if they use the current deadline the final enrollment figures are going to make them look bad. If they had ever had any concerns about viability or good government they would have made many different decisions along the way.

  • The administration is claiming that five million people have at least begun the enrollment process. That means that something less than that are actually insured. If the proportion of those who are actually insured who were previously uninsured are as the surveys suggest, about 1 million people who were not previously insured are now insured via Healthcare.gov. I think they look pretty foolish going to the barricades to insure such a small proportion of the uninsured.

  • Guarneri

    Hmmm. Doesn’t understand as in stupid? I doubt it. Doesn’t understand as in willful malevolence? Probably. A few broken eggs for an omelette etc.

    It seems to me the time for “we don’t know yet” wrt this initiative is past. Its a godawful mess, Harry Reid’s liars and a couple commenters here bizarre defense notwithstanding. Let’s be charitable and say the net effect has been double, or two million newly covered, against the advertised 50 million need (how soon until that figure gets buried by ObamaCare apologists?) We have gone through this for a 4% “solution?”

    As they like to say on the sports shows currently – “c’mon, man!”

  • Guarneri

    Ooops. Just saw Dave’s previous entry……

  • Tim

    I’m at what’s probably the mid-to-older end of the ‘young invincibles’, being in my late 20s, and unlike most of my age cohort, I’ve always been able to get employer-sponsored health care since leaving college.

    I also have substantial student debt, a new-ish mortgage, and a growing 401k plan. I make too much to qualify for subsidies, but it’s also not like I have hundreds of dollars a month in my budget for ‘health care.’ I’ve thought long and hard about it – if I made my exact salary but as an independent contractor and had to get my own health care, I think I’d probably just pay the penalty. The costs are too high, the penalty too low for me to do anything else.

    Note that this also means that I am less likely to gamble and leave my job to start a business on my own – something which we as a society seems to think is a “good thing.” I have friends in Canada who, partly because they don’t have to worry about that, have felt more confident to start a business. I’m surprised that angle isn’t played up more in the talk about reform (or why Obamacare doesn’t meet objectives).

  • steve

    “It seems to me the time for “we don’t know yet” wrt this initiative is past.”

    We arent even through the first sign up period yet. Are you then advocating that any fuyure health care plan which is not running well 5-6 months into the program should be ended?

    Steve

  • michael reynolds

    It’s 6 million, actually.

    It’s a mistake to poo-pooh the already insured. Many of those “already insured” weren’t. They had the kinds of bullshit policies that to Republican minds constitute the good old days: policies that topped out at ridiculously low numbers, policies that could be canceled the instant they were required to pay out, policies that treated women as second-class citizens, policies full of loopholes, policies that didn’t cover much at all.

    So real policies are now replacing fake policies. That’s a good thing, and it’s real progress. I’m being hit with emails from insurers touting benefits that only exist because of Obamacare and if I can find the time I’ll take a look.

    I am thrilled with the change Obamacare has wrought. Unlike many folks, I still have a functioning imagination and can see where a bullshit policy might leave me: uninsured, exposed, bankrupt. So, I am relieved for myself and my family.

    6 million. Within spitting distance of the original projection, despite the atrocious roll-out and incessant Republican lies and attacks.

  • jan

    “It’s 6 million, actually.”

    I’m not sure where that exact number arose from, certainly not from figures released by the government. According to McArdle’s article, sign-up figures were 5 million as of March 17. It is pure conjecture what they might have been had the dead-line been honored, rather than deceptively delayed. Again, according to sign-up rates (McArdle’s piece), speculation has it that such a number could be anywhere from 5,700,000 to the low 6 million figures. However, this is only sign-ups and not crunching a real number for paid enrollments (20% who have not paid), which is the real number that counts in the real world.

    Furthermore, there is no breakdown of demographics dealing with age, poor health of the enrollees, or even how many constitute those who were previously uninsured. In fact, estimates are that most of these government-lauded figures are people already having insurance coverage — with only 1-2 million making up the pie chart of the previously uninsured. Then there is that 6 million policy cancellation number looming over this whole HC fiasco, which in a bizarre way seems to indicate that either more people are not covered by the PPACA implementation (so far), or that it has simply become a ‘wash,’ without the needle of the uninsured moving much at all — especially grim, considering the considerable inconvenience, money, time, and political capital invested in this enormously controversial piece of legislation.

    Lately, little is being said, too, about the ‘back-end’ of the web-site still not working. This means that more money is being expended to compute coverage costs, along with honor systems being evoked dealing with subsidy qualifications and now sign-up deadlines. No private sector business would survive on this kind of erratic roll-out and finger-in-the-air machinations that has been demonstrated by this government devised HC system. Also, because there is so much inconclusiveness about how this thing is going to end up, premiums are also in the wind, floating around as to what they will be in 2015. Supposedly, insurance companies gave the 2014 rates the benefit of the doubt. But, they won’t be able to continue such fiscal hospitality indefinitely, should the bottom line not develop according to the government theoretical projections.

    ” Many of those “already insured” weren’t. They had the kinds of bullshit policies that to Republican minds constitute the good old days:”

    Those “bullshit” policies as you like to parrot them to be, Michael, are probably similar to what dems (Mark Warner, specifically) are now pushing, called copper policies — basic policies enticing those to the table who want more of a low-cost catastrophic plan, like the ones they used to have. Doesn’t it seem odd to berate someone’s HC policy, cancel it, and then introduce a facsimile to the one called ‘sub-par’ in order to make this whole PPACA work?

  • michael reynolds

    Jan:

    http://www.nytimes.com/2014/03/28/us/politics/white-house-says-6-million-have-enrolled-for-health-insurance.html?hp&_r=0

    WASHINGTON — The White House said on Thursday that more than six million people had signed up for medical insurance plans under President Obama’s health care law, exceeding the administration’s revised goal for enrollment by the Monday deadline.

    Demand for new policies has surged in recent days as the open enrollment period draws to a close, the White House said, with 1.5 million visits to HealthCare.gov and 430,000 calls to the program’s call centers on Wednesday alone. The enrollment figure is up from five million a week ago.

    That’s why you shouldn’t get all your “news” from Hannity and Limbaugh.

  • michael reynolds

    Jan:

    As for the bullshit policies, they’re just that: bullshit. People with no idea what a catastrophic illness costs buy policies that tap out at 50 grand and can be canceled on a whim. I know you need to pretend everything was great back in the good old days, Jan, but that, too is bullshit. Health insurance was fraud on a massive scale. Now it’s real. It’s the difference between fool’s gold and gold.

  • michael reynolds

    Jan:

    Oh, and you’ll like this too, and I know you won’t hear about it from Fox News:

    “Reflecting the sense that the debate has gone on long enough, more of the public would like to see Congress keep the law in place and work to improve it (49 percent) or keep it as is (10 percent) rather than repeal it and replace it with a Republican-sponsored alternative (11 percent) or repeal it outright (18 percent).”

    That’s 59 to 29 keep over repeal. I’m not great at math, but I’m pretty sure that makes it 2-1. Two to one, after years of you people screeching about negro tyrants and death panels. Two to one.

    http://wonkwire.rollcall.com/2014/03/26/poll-let-obamacare-stay/

  • jan

    Nice links, Michael.

    However, when I disputed the 6 million number, it was because the exciting WH memo was just making it’s media rounds yesterday. Of course I should have guessed that something magical had happened when I noticed balloons gleefully streaming from the roof line of the Oval Office.

    It’s kind of funny, though, that all these many months Secretary of HHS Sebelius has answered in the negative when being queried about actual enrollment numbers. But, somehow, after a massive web site rush two days ago, all of a sudden we have decisive numbers that everyone is now to believe are true! I just can’t help wondering, though, if any of those spectacular figures include people just checking that new blue box, indicating merely an interest in enrollment, which then automatically extends the deadline another couple of weeks????? However, we won’t know anytime soon about such details, as details are something this administration selectively reveals, determined by what is either a help or a hindrance to the programs or ideas they are hawking at the moment.

    As for those percentages denoting a polling sample of those who desire to change the law versus the likelihood of appeal, I think people are kind of depressed about the role of government in their lives these days, demonstrating their sense of futility that Obama’s legacy legislation has any chance of being simply eliminated. It’s a proven rule of thumb that once the tentacles of government has encircled citizens, it becomes like crab grass — difficult to weed out. The sad thing about your written victory dance, Michael, is that it comes at a price of joyless acceptance, as all current polls show a continuing dislike for this HC law, which, very much like Putin’s way of getting things done, is by sheer force not cooperative compromise.

  • michael reynolds

    Jan:

    Yes, forcing people to buy valid health insurance policies rather than letting them ride free on the backs of people like me who do buy health insurance and also pay taxes to support them, is exactly like an armed invasion. No, it’s worse than that, it’s like lining Jews up at the gas chamber! It’s the end of freedom! We’re all gonna dieeeee!

    Meanwhile, is car insurance optional? No? Huh. So I guess freedom was already dead.

  • jan

    Michael,

    Most people in the U.S. already had valid health insurance policies — some 85-90% who said they were happy with them. Who are you then, or the government for that matter, to butt in and redefine what they freely chose for themselves, crassly calling their coverage something else but valid, and substituting their own tiers of HC plans that bureaucrats think are best for you?

    Furthermore, having HC insurance is basically a promise of care. However, if medical services and physicians are excluded from exchanges, such a promise is either diluted or not fulfilled at all. In the case of the PPACA, it’s provisions and mandates are shrinking and alienating medical facilities, many doctors, cutting back on nurses, decreasing work hours in businesses, which negatively effects overall health care as well as employment opportunities. This is a lose/lose government program, anyway you want to spin it.

    As for your example of car insurance, there are state-by-state differences in what is mandated, similar to what most reasonable people want for health care legislation — which is to have each state decide their own health care constructs for themselves. Most states, though, do stipulate some kind of complusory liability insurance to cover personal injury and property damage to others –not extending it, though, to costly comprehensive lengths as our PPACA does in it’s insurance criteria.

    Somehow, Michael, you paint your philosophies as being so much more compassionate and humane than your conservative counterparts, when, in reality, they are gratuitous and in some cases hurt people more than they help.

  • michael reynolds

    Yeah, it’s a crazy idea we Democrats have that letting poor people see doctors, or eat, is more compassionate than the Republican approach of “I got mine, fuck you.”

  • michael reynolds

    Jan:

    I found this random quote that might explain our position. Not sure where it came from. Maybe you recognize it?

    Then the king will say to those on his right, ‘Come, you who are blessed by my Father. Inherit the kingdom prepared for you from the foundation of the world.
    35
    For I was hungry and you gave me food, I was thirsty and you gave me drink, a stranger and you welcomed me,
    36
    naked and you clothed me, ill and you cared for me, in prison and you visited me.’
    37
    Then the righteous* will answer him and say, ‘Lord, when did we see you hungry and feed you, or thirsty and give you drink?
    38
    When did we see you a stranger and welcome you, or naked and clothe you?
    39
    When did we see you ill or in prison, and visit you?’
    40
    i And the king will say to them in reply, ‘Amen, I say to you, whatever you did for one of these least brothers of mine, you did for me.’

  • jan

    “Yeah, it’s a crazy idea we Democrats have that letting poor people see doctors, or eat, is more compassionate than the Republican approach of “I got mine, fuck you.””

    Michael, I sense you are decent guy, who I strongly disagree with when discussing fiscal issues as they relate to big versus small government, dependency on ever-expanding social programs versus personal self-reliance, and government force and mandates versus encouraging incentives, motivation. and even voluntary moral outreach to help others. However, it’s not the party affiliation that makes a person good or bad. Ideology and personal philosophies on how to create a better life for all just differ within our political parties.

    For instance, I think social progressives live in a theoretical world, one that infrequently produces the end result sought in the policies they endorse . And, although their intentions may be stellar, the governing models espoused usually end up cultivating highly managed, entitlement-driven societies that find themselves eventually struggling for more resources to fund what they have ideally created in their social agendas.

    Conservatives, though, seem more apt to look for avenues helping people strengthen themselves, adding to society rather than taking from it. It’s all a part of that saying, “a rising tide lifts all boats.” A country where more people are able to contribute their skills, monies, talents, enthusiasm, will thrive more, be more proactive in helping themselves as well as others, rather than the divided nation we’ve become, riddled by resentments and class envy. IOW, how you view the opposing party as being nothing more than “I got mine, fuck you” seems destructively off course, IMO.

    A comparison/contrast example, as to how differently two ideologies process one function in life, is charitable giving. Studies have shown the more liberal a demographic the less prone it is to give to others from their own wallets, as this is an expectation they have of government to fulfill. The opposite, though, is true of conservatives who are much more generous in giving to charities, crisis donations, poverty etc., as they rely on personal giving rather than expecting the federal government to take care of problems.

    As to the excerpt you posted, I’ve heard it, but am not really all that familiar with religious citations. Godly words are truly inspiring. However, it’s one’s actions, creating something real, which then causes the inspirational message to be manifested and put into practice. Consequently, I believe actual good works are far more useful then theoretical ones.

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