An Obamacare Checkup

[ Posted Monday, December 30th, 2013 – 15:09 UTC ]

It's time for a regularly-scheduled checkup (to use a medical metaphor) on how Obamacare's doing. Three months in, things do seem to be improving. So much so, in fact, that January will (one way or another) see a shift in the political discussion to other aspects of the health reform law than just the website. Whatever way the story gets spun next month, it will be different than the prevailing storyline up to this point. But before we get to that, let's take a look at the progress made in the past month.

December was pretty crucial for the website. After the interminable wait in October and November, this was pretty much the last chance for the federal insurance exchange site. But now that the numbers are starting to leak out, it looks like the website performed not just competently, but downright admirably once all the fixes were in.

December was always going to be a "spike" month for the program, due to the deadlines built in to the system. This was exacerbated by the pent-up demand from October and November (all those people who had waited until the website was pronounced fixed before trying to access it). But even under this heavy load, the website held up. Rather than freezing up or giving error messages, there was a newly-added safety valve built in, and it seems to be working as designed. On the website's biggest traffic day (last week), even with over a million people accessing the website on the same day, the wait times were reported as only seven minutes, after the safety valve ("take a number, leave your email, and we'll contact you when you can log on") was turned on. That's a pretty acceptable wait time for such a high-volume day.

Also encouraging on this front was the reported fact that the safety valve was dynamic -- the website operators could adjust when it kicked in, to deal with whatever load problems developed. On the first day of December, there was an initial rush (after the White House proclaimed the site up and ready) and the "take a number" feature was set to kick in when the system got over 30,000 users simultaneously. The specification for the system had initially been 50,000 simultaneous users. But by the biggest spike at the end of the month, the system was successfully handling something like 80,000 users at once, before the safety valve was turned on. That is huge progress, and bodes well for the final projected big spike (at the end of March). So my initial fears of the newly-fixed website being overwhelmed by a December spike were not realized, thankfully. Whoever programmed (or came up with the idea of) the safety valve feature deserves a fat raise, that's all I can say.

The White House has been controlling the data flow about the website with considerable political finesse. They initially announced that they'd only release numbers once a month, but this still leaves them free to leak numbers whenever they wish (whenever the numbers look particularly good, to put this another way). We've just had such an "authorized leak," so let's take a look at what's being reported.

In December, it looks like the number of people who successfully signed up for private insurance on the federal Obamacare website (this doesn't count people who signed up for Medicare or Medicaid, in other words) was over a million. The other figure I've heard batted around is that when you add in everyone who has signed up since the October launch -- including those who have signed up through state exchanges -- that a total of around two million people have now successfully signed up.

The last time I looked at the numbers was in November, when the official pre-leak for that month happened. The final numbers were pretty close to the initial numbers, and what they showed was that around 500,000 people had signed up in October and November (on both the federal and state exchanges). But the target that had been set was to sign up at least seven million by the end of March. Two months into a six-month window (one-third of the period), they had only hit one-fourteenth of the target. Which was pretty worrisome.

Now, however, the numbers look a whole lot better. If the leak proves true, it would mean that approximately 1.5 million people signed up in December. Now, December was a "spike" month, and this number will likely go down in January and February, but then will reach what will possibly be an even-larger spike when the final deadline nears. So while it's tricky to use averages in this case, doing so nevertheless shows that Obamacare could come very close indeed to the initial estimate. If the next three months are as successful as December was, that would mean an additional 4.5 million people signed up. For a grand total of 6.5 million -- pretty close to the initial target set. So, even with the inaccuracies inherent in this sort of averaging, it's at least within the realm of possibility that Obamacare's numbers will look pretty good by the end of March. Which is, significantly, the first time that claim could ever realistically be made.

With the website largely fixed and the deadlines passed for insurance policy cancellations, the stories in the media are going to shift. What they shift to remains to be seen. Both Democrats and Republicans will be trying to influence this storyline, meaning we're in for a month of fierce political spin, folks.

Republicans will be scouring the land for personal stories of any failure in the new system. While the error rates are way down (below one percent), there will undoubtedly be stories of people who thought they were insured and who went to a doctor, only to find out that the insurance company doesn't have them on the rolls yet. Perhaps there will be people who "can't find a doctor" on their new plans. I'm sure Republicans will be diligent in digging out such stories.

Democrats will be pushing more positive storylines, of course. The best ones will be "I visited a doctor for the first time in years, and can now get my medical problems treated without entering bankruptcy." This, after all, was the whole point of the Obamacare program. A video of some poor soul weeping tears of joy after receiving their first cancer treatment will be a good example of this.

The real question is which one the media will run with. Perhaps at the start, the two storylines will be balanced. But after a few weeks, the problems of "not having my insurance card when I thought I was insured" will likely fade, as the insurance companies fix individual problems. The official release of the website numbers for December will come mid-month, which could also bolster the positive storyline. Of course, problems with insurance companies didn't begin when Obamacare was passed (they were, in fact, the reason for passing Obamacare in the first place), and they're not all magically going to end overnight either. So there will always be stories of people seriously annoyed at health insurance companies for one reason or another.

Democrats are finally going to be given a chance to argue Obamacare on its merits. They really didn't do so very well when it passed (from Obama on down), and they really couldn't very well do so while the website was limping along. Which cleared the field for scaremongering, of course. Democrats would do good right now, though, to do a little opposition research -- go back and mine all the quotes you can find from Republicans from the past three years or so. Find every single example of some Republican saying "Obamacare will mean that X is going to happen," and then highlight them prominently to remind the public "Obamacare is now up and running, and X did not happen." Start with Sarah Palin's "death panels" and work your way forward, right up to the present. Find every laughable prediction you can, and start debunking them all in the media right now.

Republicans are not being shy about letting it be known that their entire 2014 congressional campaign will not just revolve around or be centered on, but indeed will consist solely of attacking Obamacare. For Democrats, it's not just about making the argument in January to win some sort of media war over the issue. This is going to be the whole 2014 campaign to Republicans, and Democrats had better be ready to fight back on this battlefield if they have any hope of doing well in the upcoming midterm election.

-- Chris Weigant


Cross-posted at The Huffington Post

Follow Chris on Twitter: @ChrisWeigant


23 Comments on “An Obamacare Checkup”

  1. [1] 
    Michale wrote:


    If you use the numbers that the Administration is putting out, then obamacare is doing pretty decently..

    But considering the HUGE credibility gap that this administration suffers (Biggest Lie of 2013 anyone??) do you REALLY want to put all your eggs in that basket???

    Further, signing up is just half the battle.

    Let's see what happens when the insurance companies don't get paid before we shelf the Train Wreck idea, eh?? :D


  2. [2] 
    Paula wrote:

    Happy New Year Chris!

    Just stopped by quickly -- was out most of last week and will be out most of this. Your awards columns were good btw.

    Had to comment here because I remember commenting not too long ago that I felt pretty confident the ACA website's problems would be resolved and now feel vindicated! The thing was, the problems with the website were definable and fixable. What it needed was time, organization and skilled personnel. Simple exercises in competence (though the competencies aren't simple). I don't want to be too complacent but overall I think we can breathe easier and feel reasonably confident going forward.

    Which is one of the (many) reasons repub fixation on the website was shortsighted and counter-productive.

    In 2014 may they reap what they sowed.

  3. [3] 
    Michale wrote:

    In 2014 may they reap what they sowed.

    They may indeed...

    And it's entirely possible that they they sow is control of the Senate in addition to retaining control of the House...

    You heard it here first.. :D


  4. [4] 
    Michale wrote:

    And it's entirely possible that they they sow is control of the Senate in addition to retaining control of the House..

    And THAT's what I get for posting while drinking.. :D

    That should read:

    And it's entirely possible that what they sow is control of the Senate in addition to retaining control of the House..



  5. [5] 
    Elizabeth Miller wrote:


    We knew that. :)

  6. [6] 
    Michale wrote:

    We knew that. :)


    It IS going to be interesting, the dynamic around here if the GOP takes the Senate and retains the house..

    Other than me being insufferable (that's a given :D) one has to wonder how much worse it's going to get for Obama when he has absolutely NO pull in Congress at all...


  7. [7] 
    Michale wrote:

    For the record, the fund raiser ends at midnight TOMORROW night, right??


  8. [8] 
    Elizabeth Miller wrote:

    Would you like to extend the deadline? :)

  9. [9] 
    Elizabeth Miller wrote:

    It doesn't really matter to me, you know, since I've pledged $0.25 for each of your comments up to a maximum of $200.00 and I've promised to send in the maximum even if you don't reach 800 comments.

    But, in such case as you fail to reach that particular milestone, I will endeavor to make your life at most enjoyable throughout 2014, more enjoyable than usual, even ... if you know what I mean, and I'm sure that you do! :)

    Happy New Year, Michale!

  10. [10] 
    Michale wrote:

    Would you like to extend the deadline? :)

    Naw, I think that Weigantians would collectively blow a gasket if I REALLY cut loose.. :D

    I plan on holding some various "contests" today and tomorrow to get my donation count up.. :D


  11. [11] 
    Michale wrote:

    Obamacare checkup???

    Well, let's see....

    There was supposed to be 7 million Americans enrolled in obamacare by now..

    Real count?? Just over a million...

    And when one takes into account that 4 to 5 million Americans have LOST insurance......

    Well.... THAT's a train wreck, no matter what litmus test you use..

    Let's see what happens in 2014 when insurance companies can't get paid..

    It's gonna be a wild new year....


  12. [12] 
    Michale wrote:

    Happy New Year, Liz! :D


  13. [13] 
    TheStig wrote:

    M (1)

    The notion that insurance providers might not get their subsidies and subsequently dump enrollees doesn't seem to have gained traction since it was broached by Politico (and maybe other sources) over a month ago.

    The problem doesn't seem all that complicated.
    The insurance provider knows the amount of the subsidy, based on calculations made during the enrollment process. So does the government. So does each enrollee, if they choose to look, but that's optional.

    The insurance company forwards the bill to the government, just like they forwarded my unsubsidized portion to me. It's not like the government has to track and pay millions of insurance companies. At most, I'd imagine it's a few thousand checks. It could probably be done by hand if it came to that. Auditing the payouts will be harder, but the government has some expertise at that. The insurance providers will put up with short term glitches to reap long term profits from an expanded health insurance market place.

    You predict swarms of unsuspecting enrollees will be dropped due to unpaid subsidies, I say that's hogwash, wishful thinking based upon last month's hyperventilation over at Politico.

  14. [14] 
    Michale wrote:

    You predict swarms of unsuspecting enrollees will be dropped due to unpaid subsidies, I say that's hogwash, wishful thinking based upon last month's hyperventilation over at Politico.

    So, out of the goodness of their hearts, the insurance companies are going to pay for people's health care, even though they (the insurance companies) haven't been paid for their services..

    Have you MET our insurance companies?? :D

    This is an example of what's going to happen...

    At most, I'd imagine it's a few thousand checks.

    Well, considering the crappy turnout for signups on TrainWreckCare and the exorbitantly high costs and low subsidy qualification, you might be right..

    But if TrainWreckCare has the tens of millions of Americans enrolled as ya'all seem to THINK it will, then it's going to be a LOT more than just a "few thousand" subsidy checks..

    It's like saying the IRS can process refunds by hand because there is only going to be a "few thousand" who get refunds..

    But, like I said, since it's becoming apparent that very few Americans are going to qualify for subsidies and will, therefore, be unable to afford TrainWreckCare, you might actually be correct about the "few thousand" claim..


  15. [15] 
    Michale wrote:

    Well, shall we do a "checkup" of TrainWreckCare??

    Oregon Mother: I Can’t Afford Obamacare For Myself, 1-Year-Old Son

    NE Houston hospital unable to pay employees, blames new Medicare payment facilitator

    Insurance Customers Still Having Problems With MNsure

    It’s official: Obamacare debuts with more canceled plans than enrollments

    Read more:

    Poll: 59 percent report negative experience with ObamaCare

    More New Taxes and Fees: How You’ll Pay for Obamacare in 2014

    The Year Ahead for Obamacare
    The Affordable Care Act faces multiple challenges in 2014
    Hundreds of thousands have signed up for the new plans. However, it remains to be seen if the insurance companies received accurate information through the faulty website If they did not, it is an open question as to whether or not those who think they are insured actually have coverage.

    Improvements to the back end of the website—the part that transmits information from the federal agencies to the private insurance companies that are actually insuring individuals—have been less than impressive, as insurance companies were complaining as late as mid-December about getting incomplete and faulty insurance applications.

    'They had no idea if my insurance was active or not!': Obamacare confusion reigns as frustrated patients walk out of hospitals without treatment
    MailOnline spoke with patients who were told they would have to pay their bills in full if they couldn't prove they had insurance
    One was faced with a $3,000 hospital room charge and opted to leave the hospital after experiencing chest pains
    'Should I be in the hospital? Probably,' she said
    Another, coughing in the cold, walked out without receiving a needed chest x-ray
    Consumers face sticker-shock from medical costs under the new Obamacare system, made worse if they can't prove they're insured
    As many as one-third of new enrollees' applications have seen problems when the government transmits them to insurance companies

    Emergency Visits Seen Increasing With Health Law

    Now, if any of ya'all have any SUCCESS stories to match the horror stories???

    Well, like little ole Ross Perot said, "I'm all ears".... :D

    If this were truly a checkup, then this TWC "patient" would be at death's door...


  16. [16] 
    Michale wrote:

    Harvard study: Medicaid actually increases ER visits

    A Harvard University study published Thursday concludes that Medicaid enrollment significantly boosts emergency room visits.

    This is in direct contradiction to the Obama administration’s claims that his healthcare reform law would put a dent in costly visits to the ER as a way to cut spending.

    Ooops... Caught in another lie....

    The horror!!! The infamy!!! The ignobly!!!

    Oh wait.. This is a DEM Potus...

    Eh, no big deal...


  17. [17] 
    Michale wrote:

    You predict swarms of unsuspecting enrollees will be dropped due to unpaid subsidies, I say that's hogwash, wishful thinking based upon last month's hyperventilation over at Politico.

    With TWC, who has been more correct in their predictions?? :D


  18. [18] 
    TheStig wrote:

    M (14)

    You think the government is going to send a separate subsidy check to the insurance company of each enrollee? No, they will bundle all the subsidies due to each insurance provider and issue each provider one check at some regular interval. Saves paper and stamps!

    The subsidy is computed at enrollment, each insurance company knows what it is owed per month, as does the government. The enrollment data will updated regularly, discrepancies will be ironed out between the government and its insurance contractors through standard procedures well known to both insurance company and government bureaucrats.

    If the government purchases 1 million pencils from ABC pencil company, it cuts one check to ABC each month, not 1 million checks.

    You are making a mountain out of a pretty routine mole hill. The insurance companies will get paid. That's my prediction.

  19. [19] 
    Michale wrote:

    You are making a mountain out of a pretty routine mole hill. The insurance companies will get paid. That's my prediction.

    Your prediction is based on best case scenarios and does not take into account the problems that TWC has already had and the future problems that are germane to a half-assed website that was thrown together by an apparently incompetent company from a no-bid contract..

    I predict that we are going to see more and more headlines as I listed up in #15...

    But I am SURE there are going to be just as many success stories, right??

    After all, Obama paid some outfit over a million bucks to FIND success stories..

    Don't seem like he got his money's worth...


  20. [20] 
    Michale wrote:

    Doctor’s Office Spends 2 Hours On Hold With Health Insurer For Patient’s Surgery Authorization

    Unfortunately for those that support obamacare, this is going to be the norm until obamacare is repealed..


  21. [21] 
    Michale wrote:

    Hay TS...

    ObamaCare’s use expected to spike beginning next week

    Wanna meet here in 10 days and compare obamacare success/horror stories? :D


  22. [22] 
    TheStig wrote:



    Authorization by insurance companies was a pain in the tush before Obama Care and will continue to throb with full implementation. It's the nature of the insurance company:health provider interface. Of course, you can just pay for the surgery out of your own pocket and do own negotiation.

    As time goes on and more people sign up, and actually use their insurance, I think the story will shift from the insurance side of the story to cost of health care, and the outrageously high dollar per equivalent medical outcome that we in the USA experience compared to other first world countries. That's the impending horror story, because Obama Care doesn't strike me as doing much to alleviate that part of the problem.


    As long as the success:horror reports are data driven, and not the anectodal crap solicited by politicians, be they Blue or Red.

  23. [23] 
    Michale wrote:

    As long as the success:horror reports are data driven, and not the anectodal crap solicited by politicians, be they Blue or Red.

    Fair enough...

    Most of what I have been reporting on comes from actual people and their experiences with TWC....

    Never met a politician who could tell a straight story...

    We'll see what things are like in a week or so...


Comments for this article are closed.