WASHINGTON POST
March 23 marks the Affordable Care Act's fourth anniversary, and March 31marks the deadline for people to sign up for health insurance before fines kick in. That means that people are going to be talking quite a bit about the health care law and how its implementation is going.
The Kaiser Family Foundation has released information about how many people have enrolled in health-care exchanges in each state through March 1. Where people are signing up — and where people aren't — tend to follow an easy political rubric. Out of the entire population eligible to join the health-care exchanges, 15 percent have already signed up, a number likely depressed by the Affordable Care Act's inelegant Internet debut. In conservative states where the exchanges are run by the federal government — 27 in all — only 12 percent of the eligible population has signed up. In the 17 states that built their own exchanges, 20 percent of eligible people signed up. Even when you break down the state-based exchanges by party, the percentage of the population remains the same. ...
.... some of federally facilitated exchanges have had great success in signing up people. In some states where Obamacare has incredibly low approval ratings, people are signing up in extraordinary numbers. In some states where the health-care law is popular, sign-ups are nonexistent.
What gives?
Here's a look at a few states that show how complicated analyzing Obamacare's success can be this early in the game. The law definitely hasn't performed to initial expectations so far, but there's no doubt it's also found success in unanticipated places.
Hawaii has had the fewest number of sign-ups in the whole nation — 4,661 — mostly due to extended technical problems and little interest from small businesses. Because so few people are enrolled, the state isn't sure it will be able to pay for the exchange when the hundreds of millions of federal dollars run out in 2016.
Maryland has only signed up 9.1 percent of their eligible exchangers, and has hired 200 additional people to work the phone lines because the Web site still doesn't work quite right. The phone lines are always busy, and the wait has frustrated many potential customers.
Massachusetts' Web site is also not working well, and is unlikely to be fixed by March 31. The state has the smallest percentage of sign-ups in the country.
Wonkblog called Oregon's Web site the "nation's worst Obamacare site" yesterday. They just completed a $228,000 review of their technology, and are trying to figure out what to do next. Joining the federally-run HealthCare.gov is an option. There are many state-run exchanges that have been far more successful. California and New York — which have two of the largest uninsured populations — have together signed up over 1.1 million people. Idaho has the fifth highest percentage of sign-ups by eligible population, although only 36 percent of its residents have a favorable opinion of Obamacare.
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Hisham Uadadeh walks out of Leading Insurance Agency after enrolling in a health insurance plan under the Affordable Care Act on February 13, 2014, in Miami. (Photo by Joe Raedle/Getty Images)
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The conservative state government of North Carolina decided not to build a state-run exchange — which would usually mean a small number of sign-ups, if you were to look at most of the states that followed the same course. But North Carolina, Maine and Florida have managed to sign up a significant number of people — when adjusting for the across- the-board decreased standards following the messy November rollout — despite the fact the state government hasn't been as aggressive in pushing sign-ups as states running their own exchanges. In North Carolina and Florida, the number of sign-ups looks promising to the Obama administration since they are two of the ten states with the highest number of uninsured residents. If the Obama administration's last-minute advertising blitz in these states — which also include California, Texas, New York, Georgia, Illinois, Ohio, Pennsylvania and New Jersey — they will get the national tally of sign-ups to go up considerably, too. And that national number is the one everyone will be looking at to give the Affordable Care Act the first semester grades that will define it for November elections.
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| Maria Burciaga (left) shops for health insurance with the help of navigator Anna Ray at a Houston art gallery. Texas ranks the lowest among states for Obamacare sign-ups. |
Texas — where one in four people are uninsured — is likely a lost cause for sign-ups in the near future. The state passed laws this January that makes it difficult to become a navigator, the people who walk enrolees through the complicated sign-up process. Only 39 percent of Texas residents have a favorable opinion of Obamacare. Conservative candidates who have been all over television commercials the past few months have focused much of their attention on the law.
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| Cedric Anthony and Alysia Greer are two of the navigators working in Houston neighborhoods for United Labor Unions Local 100. |
Who knows how these successes and slip-ups will change in the next years, but it's important to note that there's no one story to tell about the Obamacare rollout, as we learn more data about premiums and sign-ups and Medicaid enrollment in the upcoming months. With such a complex law, there's probably no way we'll know what to make of Obamacare by November. The only thing we have for sure is a crash course in what's working in some states, and what's bombing in others, regardless of whether people like what's happening or not. With such a confusing portrait, it's especially easy for politicians to spin the law every which way. This election, you're going to hear a million different things about Obamacare, and as the above snapshots show, about half of them could even be right.