Today’s a big day for Obamacare: It’s the deadline to buy private insurance on the federal exchange. But it’s a deadline in the same way that April 15 is the deadline to file your taxes with the IRS—which is to say, it’s not really a deadline at all. Thanks to yet another last-minute rule change from the White House, you can now file an extension to sign up for insurance the same way you can get a few extra months from the IRS to finish your tax return.
Nevertheless, it’s a good time to assess the status of the law. After a disastrous rollout, which erased the political damage Republicans had sustained over October’s government shutdown, the exchanges appear to have recovered nicely. The original projection by the Congressional Budget Office that 7 million people would enroll by March 31 was revised down to 6 million after the website sputtered and crashed. But the administration announced last week that sign-ups have already crossed the 6 million figure. As my Bloomberg News colleague Alex Wayne reports today, it doesn’t seem unreasonable to expect that, when all is said and done, 7 million sign-ups will become a reality.
Indeed, Charles Gaba, the self-professed “numbers geek” behind the blog ACAsignups.net, whose calculations health-care reporters have avidly followed, raised his estimate of total sign-ups this morning to the magical 7 million number.
In reality, though, the 7 million figure doesn’t tell us nearly as much about the law’s success or failure as most pundits will insist. That’s because there’s so much we still don’t know about who has signed up. For instance, we don’t know how many of those 7 million will actually pay for the coverage they signed up for (some early studies have indicated 80 percent to 85 percent). We don’t know how many will be young people—desirable for their general good health and consequent ability to keep costs down—or how many will be healthy. And there’s certain to be variation among the states; some will be healthier than others and that will affect future costs. The next big test will be how insurers set their rate premiums for next year. If, as some conservatives predict, rates skyrocket, then the White House will have a very big problem on its hands. But we won’t know the answer for many months.
What I do think we know is that the law is here to stay. If you ignore the Jack Welch-like conspiracy theories being propounded by some Republicans—Wyoming Senator John Barrasso told Fox News he thinks the White House has “cooked the books”—it’s clear that millions of people have gained coverage that simply can’t be repealed. There’s the roughly 7 million who will have signed up through the exchanges; the 3 million young adults who can stay on their parents’ insurance; and the millions more who have been covered by Medicaid. Add to that the Republicans’ continued unwillingness to put forward and vote on an Obamacare alternative. It’s true that polls routinely find that the law remains unpopular, although sentiment has improved. And that will exact a political cost. What seems likeliest to me is that Democrats will lose the Senate in November in part because of Obamacare’s struggles, but find comfort in knowing that the law itself won’t be repealed.