October 25, 2013

[h/t Heather]

It will be a great day in this country when journalists actually ferret out facts instead of basing their reports on a set of talking points from one side. Today's exercise in concern-trolling comes to us courtesy of CBS News.

CBS News is very, very worried that early reports about signups for coverage under the Affordable Care Act are weighted toward Medicaid recipients. That talking point comes straight out of the insurance industry, who is expressing concern that they will get the sick people (aka poor folks who haven't had access to healthcare) signing up --but not healthy ones.

It's nonsense for a couple of reasons. First, some states where Medicaid was expanded initiated campaigns to get people signed up ahead of the January 1st date, like California and Oregon. Getting those people into the system early is a good thing, not a bad thing.

Second, Medicaid enrollment processes are already in place and administered by the states, which means a more streamlined and faster enrollment process.

Third, it was expected. The most recent CBO forecast on enrollment expectations projected that 9 million people would be signing up for Medicaid/CHIP compared to 7 million enrolling in the private exchanges. The expectation is that over time weighting would shift the other way, under the assumption that economic conditions will improve.

Beyond that, there seems to be an almost-fetish about taking early numbers and trying to call them a trend. Lest we forget, enrollment has been open for exactly 24 days, and we all know about the issues with the online experience of enrollment. Perhaps a look at Massachusetts' experience in their first year will help.

My favorite ACA wonk Jonathan Cohn explains:

The main reason for low enrollment will be that people don't sign up for health insurance programs right away. They wait until the last minute. This is true of public insurance and this is true of private insurance. And while you've heard people (including me) say this for months, this is one of those cases when numbers tell the story better than words. And there are some numbers very few people have seen.

The numbers are from Massachusetts, the state whose health reforms became the template for the Affordable Care Act’s coverage expansion. The place to look is within what’s known as the “Commonwealth Care” program, which is where people getting private insurance subsidies shopped for plans—in other words, an analogous structure to the new federally run exchanges.

And again I repeat: Exchanges have only been open 24 days.

As for insurers' concerns, here's some customer feedback for them. I went to CoveredCa.com, the California insurance exchange on October 1st. Like just about everyone else on the planet, I had trouble with the website that day, but later in the day I was able to complete the data entry and receive a summary of plans available to me. After reviewing my options, I went to find out who was in the provider network for the Silver plan I was contemplating only to find out the insurer hadn't released that list. As of this writing, the list is still not released, and that will have a material impact on what plan I choose.

Insurers, if you want more people enrolling via the exchanges I suggest releasing provider information so people know what choices they'll have inside the network.

As for CBS, there are plenty of stories to tell about health care and other things happening in the world. Perhaps it would be good to allow this story to ripen a bit before wringing your hands over it.

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