The first open enrollment period under the Affordable Care Act ended this week with roughly 7.5 million people obtaining policies through the new state insurance exchanges, including more than 1.3 million at Covered California. That's an amazing and welcome result, considering how badly many of the exchanges stumbled when sign-ups began in October. Nevertheless, it's far too early to judge the success or failure of the healthcare law, given that key tests of the program's sustainability have yet to be passed.
Almost all of the exchanges got off to a wretched start, particularly the federally managed ones that shared a mind-bogglingly dysfunctional website. And yet, as Covered California Executive Director Peter V. Lee predicted last year, sign-ups increased dramatically as the deadline for enrolling approached. The results are significantly better than had been projected in California, and modestly better for the country as a whole.
It's hard to say how much headway the law is making toward insuring the uninsured, however. The exchanges didn't measure how many of their new enrollees had previously lacked coverage, as opposed to the number who signed up because their old policies had been canceled or because they were no longer covered at work. Although two recent surveys show a sharp drop in the overall percentage of uninsured Americans, analysts at Rand Corp. say most of the increase came from people gaining coverage through an employer, not the exchanges. And the refusal of about half the states to expand their Medicaid programs has left millions of poor American adults unable to afford coverage.
Nor do we know yet whether the exchanges' customers will find their new plans adequate. Many of those who signed up have yet to seek treatment from their new plans' more restricted (or "narrow") networks of providers, one of the key cost-saving steps insurers took in Year One. Another outstanding question is what will happen to premiums at the exchanges, which will depend to a great degree on the demand for healthcare from the new enrollees. Covered California's early results bode well for future premiums because they suggest that insurers signed up more consumers who are comparatively young and healthy than expected. But the first real indication won't come until June, when insurers actually file their rates for 2015.
With any complex law, some pitfalls don't become clear until after implementation begins in earnest. That process is well under way now for the Affordable Care Act, and it's encouraging to see the exchanges exceed their enrollment targets despite the manifold problems they've experienced. And we clearly are making progress toward the goal of increased insurance coverage. It's just too early to tell whether that progress is truly sustainable.Copyright © 2015, The Baltimore Sun