ACA supporters hope sign-ups will continue until April Fool’s Day begins.
The problems with the Healthcare.gov launch were well documented and chewed over in the media: In the early months, many reported that the site was down when they tried to buy insurance. As a result, only 365,000 people enrolled in October and November — nowhere near the 1.2 million originally expected.
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.