Sunday, February 16, 2014

Reality Check on Health Exchange Bottom-Line

Cannot bear very much reality.

T.S. Eliot (1888-1965),  Burnt Norton

In 1997 in the foreword to ABCs of HMOs, a Castle Connolly publication,  I wrote “Nothing brings you closer to reality than being a physician."

True enough.  We physicians are reality freaks. We daily face sickness,  disease, death, hopes, and dashed dreams.   We know what works and what doesn’t work.  We know reality.

Here is a reality check on ObamaCare,  now in its fourth month after the October 1 launch of,  one and one-half months after ObamaCare’s official January 1 start, and four years after its passage.

1.       About 3.3 million have signed up for an exchange health plan, still well short of the pace required to reach the administration’s goal of seven million by March 31, 2014.

2.       Most people are signing up for mid-range silver plans, rather low end bronze plans or high end gold or platinum plans.  This may be because silver plans have special cost reductions for those whose incomes  are between 100% to 250% of the poverty line.

3.      About 80% of those signing up have paid their first monthly premium.  This puts the actual number of real enrollees at 2.64 million.   If this pace continues, 4.8 million will sign up by March 31.

4.      The young demographic (18-34) now make up 25% of signees,  in contrast to the 40% needed to make ObamaCare financially sound and to avoid the adverse selection down cycle with the dreaded death spiral.

5.      About 80% of enrollees qualify for subsidies, with 6 of 7 enrollees getting subsidies from the government.

6.       Although it is hard to believe,  the government says it does not know at this point how many of those enrolling were previously uninsured, although surveys of state exchanges indicate  only 11% were not insured before signing on.  The administration is secretive about the actual numbers, perhaps because its overarching goal was to dump the uninsured into the dustbin of history.

7.      The administration is scrambling and doing everything within its power to increase the total number enrolling and is concentrating of making the young and the uninsured a bigger part of that number.


The bottomline for ObamaCare and for is, that of yet, there is no final bottomline. The bottomline is that no one knows what lies over the horizon, least of all, the uninsured who should be what the bottomline is all about.   As things stand now,   less than half of the uninsured know that exists,  and of those that do   twice as many (47% to 23%) oppose ObamaCare.

Tweet:   So far has not generated enough enrollments to assure ObamaCare’s success, reduce numbers of uninsured, and make it work financially.

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