Now that the shutdown insanity is in a locked ward, we should expect a fevered level of attention to return immediately to the progress of the Affordable Care Act expansions. We can predict a frantic desire to know one thing:
How many have signed up for coverage in the last three minutes?
Two models come to mind for reporting this information. Model A is the New York Stock Exchange and minute-by-minute tallies and updates. Model B is the monthly unemployment statistics, out the first Friday of every month (except when there's a federal government shutdown -- d'oh!).
In Massachusetts, we had intense interest in the progress of enrollment in the early days of health reform in 2006 and 2007, and we followed Model B. Once a month, at the board meeting of the Health Connector, everyone would learn what happened the month before. That makes sense.
To my friends in the media, I have one message: please take a chill pill. You won't see 7 million enrollees for a while, and that's not failure, that's real world.
Here's the actual data on initial enrollment in Commonwealth Choice -- the unsubsidized part of MA health reform:
|Choice1 - Monthly Enrollment|
Worth noting -- July 2007 was the first month of actual coverage. Enrollment in the months leading up to July was a trickle. You can see the biggest jump in December 2007 because that is the month when the individual mandate penalty became effective -- even though it was only a $95 hit on state taxes for 2007.
Here's the actual data on initial enrollment in Commonwealth Care -- the subsidized part of MA health reform. Note, please, the difference in enrollment between the no premium and the premium paying parts of this population:
|Care 1 - Monthly Enrollment|
Inside baseball, though important -- the high rate of initial enrollment in no-premium coverage related to the auto-enrollment of tens of thousands of individuals who were enrolled in the state's uncompensated care pool prior to the passage of the MA health reform law.
Bottom line -- expectations of large-scale, instantaneous enrollment in the ACA are unrealistic and uninformed.
Massachusetts has achieved a level of coverage which is higher than the likely full impact of the ACA ever -- about 97% of all state residents. The rest of the nation should be so lucky. AND, it did not happen over night. It was a slow crawl, not a sprint.
Keep your own, and your readers', and the public's expectations at a realistic level, please. You'll be doing a service.
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