Behind the 7.1 million Obamacare sign-ups

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President Obama gloated over the administration’s figure that 7.1 million individuals enrolled in Obamacare. Time described his speech as, “A celebratory turn before the cameras.” Remember when the media last swooned over premature presidential comments? How about President George W Bush’s “Mission Accomplished” speech ten years ago?

This was the famous speech aboard the USS Abraham Lincoln where he said, “Our mission continues” but the “Mission Accomplished” poster behind him became the tagline of his remarks and the short-lived media love-fest with the president. Neil Young sang about President Bush’s speech, and his lyrics from Shock and Awe could apply to President Obama’s confident remarks as well, “History was the cruel judge of overconfidence.”

What might deflate the President’s celebratory balloons? One of the goals of the Affordable Care Act (ACA) was to provide, “Quality, affordable health care for all Americans.” According to U.S. Census Bureau data, there were about 50 million uninsured individuals in the U.S. in 2010, the year the ACA was signed into law. Since open enrollment began six months ago, the best the administration can crow about it is making a 14 percent dent in the uninsured with its 7.1 million enrollees. How many of those 14 percent were among the uninsured?

Let’s look closer at these “enrollees.” The RAND Corporation estimates that only one-third of Obamacare sign ups were from the previously uninsured. Meaning the others, or two-thirds, simply switched from their previous insurance plan to a new exchange plan. Should those be considered enrollees? Or is this simply rearranging the deck chairs on the Titanic? This would now be only a 5 percent dent in the uninsured.

How many enrollees are on Medicaid? In my home state, 57 percent of Connect for Colorado sign-ups are on Medicaid rather than an exchange plan. Since, “Enrollment is defined as the number of individuals who have picked a health insurance plan from the Obamacare marketplace,” picking Medicaid would count as enrollment. As federal and state government funds Medicaid, this expansion could have been done without all the machinations of Obamacare. The next question is whether Medicaid expansion is an Obamacare success or simply more tax dollars sucked into the maw of government entitlements.

Is someone truly enrolled if they have not paid their premium? Another RAND study notes that only 858,000 of the 7 million enrollees have paid their premiums. Hence the concern about the 90-day grace period where physicians and hospitals can be stiffed by patients who have enrolled but not paid their premiums. Counting those who have not paid as enrolled is disingenuous. Much like Amazon counting items in your shopping cart as sold, even if you haven’t actually checked out and paid.

What is the cost for the few that have braved dysfunctional websites and actually enrolled (and maybe paid) for insurance? Based on federal dollars spent on the exchanges, Hawaii and Washington DC spent $35,749 and $20,499 per enrollee respectively. For that kind of money, you could take a handful of enrollees and hire a private physician to take care of them.

So the of the 7.1 million enrollees for which the President took a ‘victory lap,’ most already had insurance, most enrolled in Medicaid, and most have not paid their premiums. And the number of uninsured, who served as an impetus for passing Obamacare, remains much the same. Yet the New York Times proclaims, “Obamacare Lives!” Seems more like the walking dead. Time will tell if Neil Young’s words about history judging overconfidence render a verdict on Obamacare and its apologists in the media.

Brian C Joondeph, MD, MPS, a Denver based physician, is an advocate of smaller, more efficient government. Twitter @retinaldoctor.