In Affordable Care Numbers it’s the Politics not the Policy that Counts

DeadlineNew Orleans    With the official 2014 deadline for much of the enrollment under the Affordable Care Act coming to a close the numbers are now over 6 million plus another 3 ½ million who have signed up for Medicaid in those states that expanded that program for more of the poor.  There will be continued mop-up on the program, which also means that there will be steadily increasing enrollments as well, and the expanded Medicare is open all the time any time. There in fact will be some enrollment over the first two weeks in April for anyone still essentially “in line” when the whistle blew.  Navigators and others are assisting with documentation on all computer problems as well as passing out paper applications which will also be accepted to still qualify people. 

            Nonetheless, we are at the point where normally sane and sober citizens would say that “it’s all over but the shouting.”  The problem is that the shouting has been incessant and will only likely continue to increase over the coming months, and the contention will grow as recognition of penalties increase as well.

            It is worth noting though how the search for the simple is already creating a narrative of confusion around the numbers and hoping that amnesia rather than analysis guides any understanding of what is really happening here.

            First, this whole thing about the numbers needs to be qualified.  The story off the shelf for everyone continues to be that the initial problems on the healthcare.gov website is the whole tale.  More recently the revised story seems to be that, hey, the national website was fixed, but look at the mess in some of the states like Oregon.  I wonder if that’s true at all.  Yes, the site was a mess and there has been a recovery, and, maybe the revised enrollment estimate by the feds from 7 million to 6 million says, “Success!”   I wonder though if there isn’t a different reality hidden in these numbers that in fact indicate that real individual enrollment has likely far surpassed even the most optimistic early enrollment estimates by the feds.  My argument would be that the exemptions given by the White House that totally postponed small employer enrollment of their workers coupled with the politically expedient exemption to allow many to keep totally inadequate and crummy insurance policies likely totals considerably more than a million lost enrollees.  And, if those now exempted numbers were part of the original goals, as I believe they were, then the fact that pure and simple individual enrollments have come so close to the original goal means that at the grassroots level Obamacare has been more popular than expected. 

            Secondly, reading the pundits searching for a new narrative, many, including a large number of health professionals and policy folks, keep arguing that the real story is still out there, and it’s not about the numbers at all.  Of course they are partially correct given that there are a lot of uncertainties and outcomes that will still be hugely important to resolve, but where they are missing the boat is that politically it’s not about the policy, or god knows we would be living in another world, and in this world it’s all about the politics.  In the political world that will determine the life and death and expansion of Obamacare in the future, the numbers, right or wrong, and the degree to which they establish the popularity of the program are right now the only thing that is really important.

            We need the number crunchers and the Nate Silvers, the darlings of big data, to take another look at these numbers and see if they don’t establish momentum and movement that could soon be changing this whole debate.  Politicians are not profiles in courage, but they are finger-in-the-wind folks with their ears to the ground listening for the sound of the stampede, and when they finally recognize it’s coming, then we’ll see the opposition finally melt away. 

            And, it may already be happening now!

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