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Keep calm and carry on

Posted by John McDonough  November 13, 2013 09:07 PM

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ACA Enrollment numbers and other statistics for October 2013 were released this afternoon by Keep-calm-and-carry-on-scan.jpgofficials from the U.S. Department of Health & Human Services. Right away, interpretations are out. The New York Times sums it up the: Health Law Enrollment Figures Far Short of Initial Estimates.

1,509,883 -- Individuals who have applied for coverage
396,261 -- Individuals determined eligible for Medicaid or Children's Coverage
106,185 -- Individuals who have selected a private health insurance plan

Of the 106,185 sign-ups, 76,391 enrolled through state marketplaces, while 26,794 enrolled through the federal exchange. Given all the problems with the website and the hurricane of publicity, I'm surprised 26,794 were able to close the deal.

So is this terrible and is the ACA heading for disaster?  Honestly, I do not believe so.  As the Broadway show tune goes: "It's not where you start, it's where you finish."  The media's continuing hyperventilation about how the law's implementation is doing, minute by minute, fits their needs, not the realities of implementing this complex law and program. 

On the other hand, the Republicans' hammering on implementation failures -- it's a good thing, and a turning point:

“By the time we reach the critical month of December, actual enrollment could lag projections by over one million people,” Representative Dave Camp, Republican of Michigan and chairman of the House Ways and Means Committee, wrote in a letter this month, accompanying a subpoena for detailed enrollment data. In an interview, he said the enrollment figures were only one part of the story. “It’s not just about the top-line number,” he said. “What I want to know is the mix of these people. What kind of insurance are they getting, what age are they?”

Are you listening?  No more repeal, no more defund -- let's talk about the details, say the Republicans.  Let's spin them in the most negative way possible, for sure.  But let's change the subject.  

By the way, the "projection" of 7 million enrollees by March 2014 -- that was the estimate of the Congressional Budget Office based on their calculation of how many enrollees would sign up.  It was not a statement of how many "had to" sign up or else the law would fail.  It was the CBO's good faith projection of how many they thought likely to sign up.  I have huge respect and appreciation for CBO's estimate, and recognition that CBO's numbers are usually wrong.

In the first month of open enrollment for coverage under the ACA, despite all the website issues and the horrible media coverage, more than 1.5 million Americans applied for new insurance coverage under the law.

We're winning.  Keep calm and carry on.

This blog is not written or edited by or the Boston Globe.
The author is solely responsible for the content.

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About the author

John E. McDonough is a professor of practice at the Harvard School of Public Health. He is the author of the book “Inside National Health Reform”, published in 2011 by More »


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