XPost: ba.politics, dc.media, soc.penpals   
   XPost: alt.burningman   
   From: tabbot@gmail.com   
      
   Enrollments in the insurance marketplaces created by the   
   Affordable Care Act soared just above 7 million. That is the   
   number of Americans the nonpartisan Congressional Budget Office   
   calculated would sign up before the federal health care website   
   launched with numerous design flaws and software errors that   
   significantly hampered enrollments. Now the key questions are:   
   What does that number mean and who are the 7 million?   
      
   To the Obama administration that number means success, a target   
   hit. As the president said in a statement released late Monday,   
   “now, millions of our fellow Americans have the comfort and   
   peace of mind that comes with knowing they’re no longer leaving   
   their health and well-being to chance. For many of them, quality   
   health insurance wasn’t an option until this year — maybe   
   because they couldn’t afford it, or because a pre-existing   
   condition kept them locked out of a discriminatory system.” In   
   his opinion, “regardless of your politics, or your feelings   
   about the Affordable Care Act, millions more Americans with   
   health coverage is something that’s good for our economy and our   
   country.”   
      
   The Affordable Care Act changed the American health care system   
   in more ways than the creation of insurance exchanges, which   
   were designed to allow consumers to comparison-shop for health   
   insurance policies in online marketplaces, where their   
   collective bargaining power theoretically fosters competition   
   and drives down prices. The president pointed out that the   
   health care reform was also meant to make insurance coverage   
   more accessible, at least theoretically, by allowing young   
   adults under the age of 26 to remain covered by their parents’   
   insurance policy and by the expansion of Medicaid. According to   
   Obama, 3 million young people are now covered by their families’   
   plans, while “millions more” are covered thanks to states’   
   voluntary expansion of the Medicaid program and the Children’s   
   Health Insurance Program. That 7.1 million-covered figure also   
   “doesn’t include the more than 100 million folks who now have   
   better care — who are receiving additional benefits, like   
   mammograms and contraceptive care, at no extra cost,” he added.   
      
   But Obamacare critics, health industry analysts, and health care   
   analysts are asking what these numbers really mean for the   
   successful reform of the American health care system. In a   
   broader sense, “the whole narrative about Obamacare — ‘Will they   
   get to six million? What is the percentage of young adults going   
   to be?’ — has almost nothing to do with whether the law is   
   working or not, whether the premiums are affordable or not,   
   whether people think they are getting a good deal or not,”   
   Kaiser Family Foundation President Drew Altman told The New York   
   Times.   
      
   It is still early to assess the full impact of the health care   
   reform, but there are several main areas were incomplete data   
   cloud the analysis of how successfully did the Affordable Care   
   Act achieve its main objective: making health insurance   
   accessible to a large percentage of the nation’s uninsured   
   population, which totaled 48 million in 2012.   
      
   1. How exact is the Obama administration’s enrollment tally?   
      
   There are a number of factors that could push the total   
   enrollment number higher or lower.   
      
   Several factors could increase the overall count; the raw number   
   does not include the latest updates from the fourteen states,   
   plus the District of Columbia, which operated their own   
   insurance exchanges. Plus, some applications on both the state-   
   run and federally-facilitated exchanges are still pending, as   
   the Obama administration has extended the signup deadline in   
   certain circumstances; and individuals will become eligible to   
   enroll after major life changes — like marriage or moving to a   
   new state, meaning people will be signing up throughout the   
   year. Plus, people who purchased Obamacare-compliant policies   
   directly through insurers have also not been counted.   
      
   But it is important to keep in mind that enrollments do not   
   equal paying insurance customers; the Obama administration’s   
   official numbers do not have information on how many enrollees   
   took the crucial final step and paid the first month’s insurance   
   premium to guarantee coverage. As Department of Health and Human   
   Services Secretary Kathleen Sebelius said Monday night on KWTV-   
   TV, approximately 80 percent to 90 percent of enrollees have   
   paid thus far. She also added that: “Lots of companies have   
   different timetables for when their new customers have to send   
   their first payment.”   
      
   2. How many previously uninsured Americans are now covered?   
      
   Given that the Affordable Care Act mandates insurance coverage,   
   expands the Medicaid program, and offers subsidies to low-income   
   households, it seems logical that to assume that uninsured   
   Americans would account for a large number of enrollments. But   
   logical assumptions are not the same as hard data, and several   
   mitigating factors must be considered.   
      
   Last fall, health insurers began canceling the policies of about   
   4.7 million of Americans that were not in compliance with   
   Obamacare regulations. While the Obama administration, facing a   
   wave of criticism, later implemented a two-year extension for   
   those policyholders, a number of them likely purchased insurance   
   coverage through the insurance exchanges before the change was   
   announced. Backing up that supposition is data from the   
   nonprofit Rand Corporation.   
      
   The organization’s unpublished survey data of 2,600 people shows   
   that nearly all customers whose policies were terminated have   
   replaced that coverage with other plans, according to The Los   
   Angeles Times. But problems of interpretations arise. In an   
   article entitled “Obamacare has led to health coverage for   
   millions for more people,” The publication noted that the   
   organization’s data showed that 4.5 million previously uninsured   
   adults have enrolled in state Medicaid programs — and data   
   compiled by the consulting firm Avalere Health reflected a   
   similar reality. The unpublished report also found that 9   
   million people purchased policies directly from insurers,   
   eschewing the Affordable Care Act’s exchanges. More importantly,   
   Rand reported that fewer than a million 2013 policyholders are   
   now uninsured because their plans were canceled for now   
   complying with the standards set by the health care reform law.   
      
   “We are talking about a very small fraction of the country” who   
   lost coverage, said Katherine Carman, a Rand economist who is   
   overseeing the survey. A greater number of holders of policies   
   that were originally cancelled by insurers were able to renew   
   those policies after a wave of backlash forced President Barack   
   Obama to implement an extension. That extension, which was   
   subject to the approval of each state’s insurance commissioner,   
   was allowed in about half of all states. And insurers themselves   
   have reported they retained a large number of their 2013   
   customers by renewing old policies.   
      
   Rand’s survey results appear to tell a story of a massive   
      
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