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We'd be remiss if we didn't take note of a positive health care reform law development: the surge in enrollment in public health insurance exchanges. The Obama administration's announcement this month that more than 7 million individuals have enrolled in the 51 exchanges administered by the states and the federal government is a huge achievement.
It was only a few months ago when many of the exchanges were so hampered by technical glitches that just getting on the exchange websites — let alone enrolling — was at many times nearly impossible.
Indeed, one month after the exchanges opened on Oct. 1, 2013, only a little more than 100,000 people had enrolled.
After that terrible start, state and federal exchange regulators, as well as outside vendors, worked hard to overcome enrollment glitches. The proof of the success of those efforts was obvious, especially in the final weeks before the 2014 open enrollment ended. During March alone, nearly 3 million people enrolled in exchange plans.
To be sure, as health care reform law critics repeatedly and with some justification have said, the 7.5 million enrollment figure does not tell the whole story. Some portion, perhaps 10% to 20% of those who signed up for coverage, actually will not enroll.
That's understandable, given the time between when an individual signs up for coverage and the time the first premium has to be paid. During that time, many things could happen, such as an enrollee landing a job with employment-based coverage, making that person ineligible for exchange coverage.
In addition, the 7.5 million enrollment figure does not correspond to a 7.5 million reduction in the number of uninsured. Some enrollees — the exact number is not yet known — had prior coverage, though likely in many cases not equal to what they will be receiving through policies obtained in the exchanges.
We hope that exchange enrollment continues to grow. As more people obtain coverage, a basic and long-time source of health care inflation — the efforts of medical providers to shift uncompensated care costs in the form of higher charges to insured patients — will be reduced.