

Only 6 people managed to enroll in an insurance plan on Day 1 of Healthcare.gov - danso
http://www.washingtonpost.com/blogs/wonkblog/wp/2013/11/01/wonkbook-only-6-people-managed-to-enroll-in-an-insurance-plan-on-day-1-of-healthcare-gov/

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Bsharp
> _" The first month of the new health law’s rollout reveals an unexpected
> pattern in several states: a crush of people applying for an expansion of
> Medicaid and a trickle of sign-ups for private insurance. This early
> imbalance — in some places nine out of 10 enrollees are in Medicaid — has
> taken some experts by surprise. The Affordable Care Act, which expanded
> Medicaid to cover millions of the poorest Americans who couldn’t otherwise
> afford coverage, envisions a more even split with an expanded, robust
> private market..."_

So you're telling me that more people who are getting free benefits showed up
to the party than people who have to pay significant annual premiums?
Shocking. I think they need new "experts".

~~~
refurb
I think what they are referring to is the impact of the individual mandate.
Sure you'd expect people to rush into the free option, but everyone who is
uninsured and doesn't qualify for Medicaid will have have to pay a penalty if
they don't buy insurance.

~~~
powertower
Pay 1.0-2.5% tax penalty for not having Insurance

Pay 10-15% of your pre-tax income for a plan under Obamacare

I don't think it's going to work out that great.

~~~
Bsharp
It depends on your expected medical costs. If you're relatively young and
healthy, saving that 9-12.5% of your income is worth it. If you're
sick/old/etc., then it's absolutely worth buying coverage. Note that in this
system the healthy don't join the risk pool.

This, my friend, is called adverse selection.

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pmorici
Perhaps because of the sticker shock and because, if you can get them, pre ACA
plans are cheaper and offer more value. For example if you go to
ehealthinsurance.com and compare the lowest cost pre-ACA 2013 plans with ACA-
compliant 2014 plans for a healthy individual in their late 20's early
thirties you get the following very affordable options pre-ACA...

BlueCross BlueShield; Deductible: $5,000, Co-Insurance: 0%, Doctor Visit: 1-2
$30 co-pay deductible waved, Cost: $98 /month

BlueCross BlueShield; Deductible: $5,000, Co-Insurance: 0%, Doctor Visit: 1-2
$30 co-pay deductible waved, Cost: $66 /month,

The closest ACA compliant option to the above...

BlueCross BlueShield; Deductible: $6,000, Co-Insurance: 0%, Doctor Visit: no
charge after deductible, Cost: $130 /month

So in summary you are looking at paying somewhere between 32% and 97% more
money, and don't get the benefit of 1-2 low cost doctors visits per year.

~~~
tptacek
Aren't you comparing conditionally-issued insurance with guaranteed-issue
health insurance? The big problem I had with sites like ehealthinsurance.com
is that a family using it to find insurance had a coinflip chance of actually
getting one of those rates after completing an application.

~~~
pmorici
Yes, but how many people is that actually an issue for? Most of the
preexisting condition demagoguery you hear about seems to stem from people who
were going w/o insurance until they found out they had a medical condition.
There were already limits on preexisting condition exclusions in a number of
states. You also have to wonder if that in and of itself is worth a doubling
in costs?

[http://en.wikipedia.org/wiki/Pre-
existing_condition#Current_...](http://en.wikipedia.org/wiki/Pre-
existing_condition#Current_pre-existing_condition_exclusion_regulation)

~~~
tptacek
Horse. Shit. I have a perfectly healthy family, a family in which I am notably
the least actuarially sound bet. When we started Matasano, we found my wife
and (at the time) 7 year old daughter both _uninsurable_ , full stop, at any
price, due not to preexisting conditions but instead previous _medical
examinations_ that led insurers to believe that at some point in the future
the two (coincidentally? female) members of my family _might_ develop a
condition.

I've talked to dozens of people since then and come to the conclusion that
"functioning human female reproductive system" is, in essence, a coverage-
denying preexisting condition in many US states.

~~~
pmorici
You're in IL right? For some reason the insurance situation in IL seems to be
really crappy. They allow(ed) for looking back further in people's medical
history than a lot of other states according to wikipedia. That doesn't
explain why the new plans are so much more expensive though even in states
that previously had restrictions on preexisting conditions and medical history
use in underwriting.

~~~
tptacek
Let's again be clear about what I said. "They" (meaning every insurer in IL)
did not "look at our medical history". They looked at visits to doctors and
(in one case) the emergency room that did not result in diagnoses, and decided
to hedge their bets by presuming a preexisting condition that was not
indicated in the record.

Another thing that happens --- particularly in California, lest you think this
is an IL problem --- is that comparatively minor medical conditions were used
as proxies for rare but expensive conditions. For instance, if you were a
woman with abnormal cramping, you might be default-denied based on a simple
blacklist of uninsurable conditions because insurers were scared that might
presage something expensive down the road.

The preexisting condition and recission policies of insurers prior to
Obamacare were a national disgrace.

~~~
pmorici
It sounds like the insurers decision had more to do with visits to the
emergency room than anything else. Those are expensive.

~~~
tptacek
Thanks for your insight.

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ceejayoz
For reference, only 123 managed to sign up for Romneycare in the first
_month_. There are clearly large technical issues, but early on it seems that
people also do a lot of "let's see how much it'd cost" and sign up later.

~~~
josefresco
Link? Would love to read up on that, if in fact it's true.

~~~
jonlucc
I agree that data is preferred, but we can also look at it another way. There
is no incentive to sign up before December 15th. All plans signed up before
then start Jan 1. With all of the talk about the technical limitations, I
think people are right to wait a month until people aren't ranting about it
being broken.

------
uptown
Completely separate issue from the technical issues - but how are people
expected to find out that they need to do this. I have to assume there's a
non-trivial percentage of the population that's not only uninsured but also
completely disconnected from news and the internet. Does somebody contact them
somehow to get them enrolled?

~~~
Bsharp
Like taxes, this will likely be a largely individual endeavor. Maybe there
will be PSAs, but their effectiveness is questionable. Many people (and the
politicians who signed it!) don't know the enrollment requirements, subsequent
responsibilities, and consequences for failure to comply.

Everyone is fighting over the validity and constitutionality of this law,
instead of informing the public about what they need to do to avoid financial
penalties. The debate will rage on no matter what, but whether or not you
agree with this law (and I don't), the priority right now should be to help
people make an informed decision about their compliance.

~~~
drivingmissm
I think civil disobedience is appropriate, and that people should resist
compliance and urge others to resist. I believe that the individual mandate is
unconstitutional and that the law was passed in a party-line vote using shady
Senate tactics. Further, we now know that President Obama flat-out knowingly
lied when he told the public "if you like your plan you can keep it." The law
needs to be delayed so that Congress can pass a bipartisan health care reform
bill. This issue is too important to not have achieved a governing consensus.

~~~
ceejayoz
Obamacare's individual mandate comes from the Heritage Foundation - that's
right, the organization now run by the Tea Party.

[http://americablog.com/2013/10/original-1989-document-
herita...](http://americablog.com/2013/10/original-1989-document-heritage-
foundation-created-obamacares-individual-mandate.html)

It _was_ essentially a bipartisan reform bill. Had Bush proposed the bill,
Republicans would likely have voted en masse for it.

As for the Constitutionality of it, the Supreme Court disagrees.

~~~
hga
This is the same organization that at the same time supported and prompted G.
H. W. Bush's "assault rifle" import ban (which we are still living with, BTW).
Whatever they might be today (I stopped paying attention to them back then),
that has no bearing on what they were a quarter century ago.

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jdmonty
So, SNL had it right when they said the site could only handle 6 users at a
time
[http://www.realclearpolitics.com/video/2013/10/27/saturday_n...](http://www.realclearpolitics.com/video/2013/10/27/saturday_night_live_mocks_sebelius_for_disastrous_obamacare_website_launch.html)

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felipesabino
I bet the data is still being processed by some of those 500 million lines of
code

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ck2
Look I am the first to be upset at how much healthcare.gov management and dev
sucked.

But I don't give a darn how many signed up on the first day.

I care how many sign up by December 31st.

Then we can discuss enrollment problems.

~~~
abarringer
No, the date is Dec. 15th. If your one of the apparently millions whose plan
didn't meet the new guidelines then you must sign up by Dec. 15th.

~~~
tptacek
The Dec 15th date is for open enrollment and coverage starting January 1. The
_mandate_ deadline is March 15. I think you have them confused.

