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First Impressions of the Affordable Care Act Rollout

The rollout has been a bumpy ride to say the least. The website still has its glitches, and the problems are being labeled President Obama’s Hurricane Katrina by many political pundits. In this week’s entry we will try to separate fact from fiction and take an objective view at the law and where we go from here.

The October enrollment numbers were only 20% of predicted targets. More than 106,000 people enrolled, but only 27,000 of those did so by way of the federal website; the vast majority of those that enrolled utilized the state ran exchanges. To put the 106,000 person total in perspective, this is only 1.5% of the anticipated enrollee total at the end of the 2014 period. To bring things closer to home with regards to our local states, Maryland had 1,700 enroll while Pennsylvania enrolled 2,207. These totals are considered low across the board but enrollment numbers seem to be improving with the November enrollment period now concluded.

While these numbers are disconcerting, optimists and supporters of the law stress for us to look at the precedent set by Massachusetts’s model in 2007. The Affordable Care Act relies on young and healthy people (those under 35 years of age) to enroll to offset the cost of those that are older and more prone to illness. If the trends seen in the MA plan stay consistent, these healthy individuals will procrastinate until the last possible second (March 31st deadline) to enroll so as to avoid the financial penalties. Jonathan Gruber, an architect of the Massachusetts plan, advisor to the President on the implementation of the federal system, and proponent of the individual mandate, stresses us to ‘be patient.’

In contrast to the multitude of issues encountered by those enrolling through the federal website, the poster boy for the state ran exchanges appears to have gotten it right. Kentucky enrolled approximately 15,000 people only 21 days after the exchanges opened on October 1st. Governor Steve Beshear heralds their website a success and claims that close to 1,000 Kentuckians enroll every day. The success of Kynect.Ky.gov highlights the advantages of a state-ran exchange and provides a framework for the federal program to glean vital information to ensure its own success.

With the November 30th deadline now past, reports are coming in that healthcare.gov is indeed improved over the debacle that was the October 1st launch, but it is not yet perfect. Concerns are that the very people the ACA relies upon for its success, the young and tech savvy generation, will be turned away if the website does not meet their expectations. This fear has increased the urgency to get the portal working as smoothly as possible, as soon as possible.

As with most laws, the Affordable Care Act is not a perfect law. It has its opponents and it has its obvious flaws. But instead of throwing in the towel, I’d like to see our nation’s leaders work together and find solutions to this law’s problems. Millions of Americans don’t have adequate health insurance and this law was intended to help those people, and those people still need health care now.

Mackenzie F. Blair,  PharmD ’15 Candidate


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