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Ethan Glover, a 23-year-old college student in Missouri, is either a hero or a villain — depending on your political point of view.
Despite Monday's enrollment deadline for President Barack Obama’s landmark health reform legislation, known officially as the Patient Protection and Affordable Care Act, Glover is not going to sign up.
He believes the individual mandate contained in the law has driven up the cost of insurance for the young. “I have no reason to get it, and prices are too high to make it worthwhile,” he said. “I don't believe in using the power of government to 'Robin Hood' people or force them to buy something they don't need or want.” Glover, who served four years in the military, said he has no plans to purchase insurance either before the deadline or after it passes.
But with the latest cutoff date almost here — albeit subject to yet another partial extension — the picture emerging over ACA sign-up rates is deeply complex. Supporters would argue that registration levels have almost hit their targets and are a great success, given the shaky start. Critics would point out that the legislation remains a political hot potato and is unpopular with many Americans who — like Glover — are still staying away from it.
What few would argue with is that the path of signing up for the ACA — as the act transitions from law to on-the-ground reality — has not been easy. Even the deadline date has been a moving target.
If you wanted an insurance plan to begin Jan. 1, 2014, then you had to enroll by Dec. 15, 2013 — until early website glitches moved the deadline to Dec. 23. If your old insurance plan didn’t meet the minimum requirements of the new law, your provider had to cancel it by March 2014 — until the Obama administration extended that deadline to October 2016.
Then there was the employer mandate provision, which requires that all businesses with 50 or more employees offer health insurance plans that meet new minimum coverage and affordability standards. It was originally supposed to go into effect in January 2014. Last year, the Obama administration announced it would be pushed back until January 2015.
I don’t believe in using the power of government to ‘Robin Hood’ people or force them to buy something they don’t need or want.
Perhaps many would not blame the public for having waited till the last second — which now looms on March 31 — to sign up for health insurance. That is the official deadline for the most commonly discussed aspect of the ACA: the individual mandate.
According to the law, by this date all American citizens must sign up for health insurance either through their employer, a private plan or a government-sponsored program — or pay a penalty. But earlier this week, those who waited seemed to be justified when the Department of Health and Human Services (HHS) announced a special deadline extension for those people who got “in line” to purchase insurance before the 31st but who couldn’t complete the process.
The exact length of the new extension remains ambiguous. “We don’t know the number of consumers who may be in line, so we’re planning enough flexibility to be able to handle everyone in line,” said Alicia Hartinger, a spokeswoman for the Centers for Medicare & Medicaid Services. “It could take a few days. It could take a week or so to work through that.”
It is also not entirely clear how the government will determine who was technically in line in time to qualify for the extension. “While there will be evidence for most of the people that they have tried to enroll, it will be hard to verify that a person tried the call center, waited, and didn’t get through,” said Hartinger. She added that it would be against the law to lie in order to get an extension.
The expectations for March enrollment numbers were high — as are the actual numbers. Last week the president told reporters on a conference call that over 6 million people had enrolled in health insurance through the federal and state-based online marketplaces that opened for business Oct. 1. Considering that through March 1 only 4.25 million had enrolled, it’s clear there was a massive last-minute push to sign up.
Beating the oft-quoted Congressional Budget Office target enrollment of 6 million is likely to be counted as a major victory for supporters of the ACA. On the other hand, the 6 million number was itself a revision of an original 7 million estimate made in September 2013. So the final push may just be making up that difference.
According to those in the field, many are finally enrolling because of issues faced in earlier months. “A lot of people I'm seeing this late in the game did indeed try to apply before but got frustrated because of technical difficulties,” said Ann Santori, a certified navigator at Enroll Lake County! in Illinois.
Technical difficulties are only one deterrent. For many, the sign-up process was bewildering. Santori pointed out that questions as simple as “How many people are in your house?” can be a significant stumbling block. Does it mean family members? People who live in your physical home? Dependents on your tax return? These complexities may have been enough to turn away those who actually wanted to become enrollees — until the threat of the deadline began to loom.
Many others may simply not have known that there was a deadline to begin with. A recent Kaiser Family Foundation poll found that 6 out of 10 uninsured Americans did not know that March 31 is a real "drop-dead" date. And others who have heard of the deadline don’t know what it means. According to Santori, many people have no idea that private insurance markets are also closing on that date. Except for extenuating circumstances, anyone who does not buy insurance by March 31 will be stuck without it until November. Despite extensive outreach and nonstop media coverage, for many the specifics of the ACA remain fuzzy at best.
Of course, some may have procrastinated just because that’s how they operate — at least a quarter of U.S. tax returns are filed in the last three weeks before tax day, for example, and the HHS says that the current rush is typical of other public programs, particularly those with open enrollment. Santori agreed: “A good amount of my '11th hour' clients are people who procrastinated."
The HHS seems committed to accommodating the rush, perhaps judging that higher enrollment numbers will offset any bad press for wavering on the deadline. Ultimately, though, the raw numbers themselves may not be as important as the makeup. In order to effectively offset the costs that will inevitably come with caring for older and sicker people, 40 percent of total enrollment must be under the age of 35, according to the CBO. If the trends from the March 11 enrollment report continue, the system may be in trouble. Cumulatively, only 31 percent of enrollees were under 35.
The White House clearly understands the issues at hand. The day the report was released, Obama appeared on Zach Galifianakis’s Funny or Die comedy show, “Between Two Ferns,” to gamely pitch insurance enrollment to the website’s young audience. On the surface, the ploy worked: over 3 million people viewed the video that day, and according to Tara McGuinness, a White House senior communications adviser who works primarily on Obamacare outreach, the site FunnyOrDie.com was the top referrer to HealthCare.gov that day. HHS representatives also say the department has shifted a chunk of its paid media budget (which totals $52 million) to CBS’ March Madness broadcasts.
The HHS maintains that the numbers are trending in the right direction. “We are encouraged by the number of individuals already enrolled,” said Hartinger. “Our experience is quite similar to Massachusetts, which has a successful risk pool.”
Ultimately, there is no way to tell until the final numbers are in. In the meanwhile, navigator programs and enrollment drives will push until the clock strikes. In Illinois, the Waukegan Public Library will hold a “Midnight Madness” event, enrolling through the last nanosecond on March 31.