Obamacare, Round 2

The Affordable Care Act (ACA), often referred to as “Obamacare,” has been successful in many big ways since the deeply flawed launch of the federal online insurance marketplace almost a year ago. By the end of the law’s open enrollment period for insurance in April of this year, over 7.5 million people had enrolled in private insurance plans through the federal and state exchanges, exceeding the Congressional Budget Office’s original projection of 7 million. (That number had dropped to 7.3 million last month; it is constantly changing due to job-related insurance changes and eligibility for Medicare and Medicaid.) In addition to the more than 7 million new enrollments in private insurance plans, 11.7 million people were found to be eligible for Medicaid or the Children’s Health Insurance Program when they visited their online insurance exchange.

Despite these successes, many supporters of the ACA — not to mention opponents — aren’t satisfied with the law’s performance thus far. One reason is that while the law helped about 19 million people get health insurance, an estimated 50 million Americans were without insurance when the law was passed. That means at least 30 million or so Americans still lack health insurance, and the law’s supporters want to get as many of them as possible signed up during the next open enrollment period, which begins in mid-November.


But as a recent article in The Wall Street Journal makes clear, getting more people signed up won’t be an easy task. One reason is that many people who signed up during the first open enrollment period were “low-hanging fruit,” meaning those who needed little persuading to sign up — either because they were previously denied coverage due to a preexisting medical condition (which the ACA outlawed) or because they were residents of an urban area with good outreach efforts by supporters of the law. Many people who still lack insurance are likely to live in rural or smaller communities, lack chronic health conditions for which they might feel a pressing need for insurance, or belong to cultural groups that are resistant to getting insurance (namely Hispanics). To add to the challenge, the upcoming enrollment period is only three months long (the first enrollment period lasted six months) and overlaps with the holiday season, when many people are busy and overstretched financially.

But groups leading the signup effort have a couple of new tools they plan to use in their efforts to persuade the uninsured. One tool is testimonials from people who have already signed up using the online exchange, something that was not available a year ago when the exchanges were brand new (and mostly not working well). Another, more controversial, tool is reminding people that they are required by law to sign up for health insurance and risk being charged a fine if they don’t (fines are waived for a number of reasons, including financial hardship). Surveys from the first enrollment period show that as many as 4 in 10 people who signed up wouldn’t have done so without the ACA’s requirement to have insurance, so signup organizers have concluded that they’ll persuade more people than they’ll alienate by talking about the law’s fines in addition to its benefits.

What’s your take on the ACA a year after the debut of online insurance exchanges — if you were skeptical of the law, has seeing millions of people sign up for insurance changed your view at all? If you supported the law, has it lived up to your expectations? Do you know anyone who has gotten insurance or otherwise benefited from the law? Should the second enrollment period be extended to later than April 15, so that people charged a fine for lacking insurance in 2014 can sign up for 2015? Leave a comment below!