With the first annual open enrollment period for the Affordable Care Act down to its final few weeks, you are going to hear a lot of spin about the numbers. The end of March will be the first real test of ACA enrollment, because as of April 1, most people will have had to enroll in a health plan that meets the law's requirements or pay a fine (equal to 1 percent of their taxable income, or $95, whichever is greater).
How many who selected a plan will have paid their premium, and if they haven't, how many will end up being dropped from the enrollment totals? How many will receive tax credits to help them afford the marketplace plans? How many will choose a plan in each tier? Will there be enough younger and healthier people enrolled to offset the costs of covering older and sicker people? If that number falls short, will it lead to a "death cycle" in premiums because insurers will have to raise rates to everyone else?
How many people will sign up for Medicaid? How many of them are newly eligible because of the ACA, and how many would have signed up anyway? And how many people who get covered by the ACA were previously uninsured, compared to those who switch from a plan that didn't measure up?
It's going to be dizzying, and for good reason. As the Washington Post's Sarah Kliff notes, drawing conclusions from the ACA enrollment numbers will be exceedingly hard "Mostly because there's no national database of who is uninsured, who has coverage, and, if they do have coverage, where they get it."
People will be even more confused by the inevitable spinning of the numbers. The anti-Obamacare crowd will selectively seize on the most negative numbers possible to try to further discredit an already unpopular law; the pro-ACA crowd will selectively seize on the most positive numbers possible to show that the law is beginning to achieve its lofty goals.
The reality likely will fall somewhere in between. Based on what we know now or can reasonably expect:
You probably won't hear a lot about the actual people behind the enrollment numbers who have gained the most from the ACA. They include 1.8 million who could not get coverage because of a cancer diagnosis and more than 2.8 million who faced the same hurdle because of a diagnosis of diabetes. "Altogether, more than 5.7 million have been diagnosed with these . . . and similarly serious conditions," reported health policy scholar Harold Pollack in a recent blog post. For the first time, many of them will have access to affordable health insurance coverage that can't be denied because of their pre-existing conditions.