In the end, around seven million Americans signed up for Obamacare by the March 31 deadline, either through the federal exchange or through one of the fourteen exchanges set up by states (plus one in Washington, D.C.) that chose to run their own. That’s the target administration officials hoped for last fall, and considering the enrollment period’s hideous rollout, it came as quite a surprise to most commentators in Washington that it was reached. Republicans and conservatives spent months predicting that few would sign up, and that the law would simply perish of its own Rube Goldberg weight. But the “death spiral” of the Affordable Care Act, so anticipated on the Fox News Channel, failed to materialize.
There was quite a rush toward the end, particularly among younger, healthier enrollees, coaxed into participation by celebrities such as NBA star Kobe Bryant and the comic actor Zack Galifianakis, whose hilarious, deadpan interview with an obliging Obama on the comedy website Funny or Die went viral and led to a surge in visits to healthcare.gov. (“Where are you planning on building your presidential library, in Hawaii or your home country of Kenya?” Galifianakis asked the president.)
These younger people are said to account for 27 percent of all enrollees—not what the administration had hoped for, but enough, according to a Kaiser Family Foundation study from last December, to avoid the substantial hikes in insurance premiums that would result if there were not an adequate number of relatively healthy young people in the insurance pool.1
This is all good news for the administration, but what really matters is not how many people sign up for coverage, but how many actually end up paying for it over an extended period. Any household hit with an unanticipated expense—a major car repair, a sudden need to buy a child a new computer—might skip an insurance payment that month. Or a healthy person might sign up, not use the insurance for a year, and stop paying or cancel. These fluctuations, too, will have an impact on premium rates by 2015, when some fear we’ll be in for substantial rate hikes, even though a provision in the law requires insurers to provide extensive justification for increases greater than 10 percent.
The truth is that we won’t know for years the actual percentage of enrollees who are sick. The reason we won’t know, it’s worth recalling, is embedded in the law itself. Insurers can no longer ask applicants questions about their health or any preexisting conditions they may have. And precisely because the law’s authors knew this little catch-22 would arise, they built “shock absorbers,” or risk mitigation provisions, into the law, by which the government would share some of the risk of loss that insurance companies assume (and conversely would be rewarded a…
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