The Vanishing Goal Posts Of The Affordable Care Act

I was surprised when Neil Cavuto announced on Thursday night on Fox Business(FBN) that the 7.1 million enrollee figure the White House was celebrating was celebrating was off. How much off were the numbers? Here is what FBN said.

Try about a million enrollees.

Not a million fewer enrollees. A million net new, paying enrollees.

Yes, we crunched the data, separated out as best we could those who already had insurance, so weren’t exactly “new” to getting insurance. Then, with the help of an expert, separated from the remaining group those actually paying for the coverage.

And lo and behold we arrived at that slightly more than 1 million paying ObamaCare customers.

Now, the White House fumed that we were leaving out the millions signing up for Medicaid and kids staying on their parents’ policies longer, thanks to ObamaCare. Fair enough, we told them, which is also why we excluded the millions more Americans who lost their health care coverage altogether.

As a numbers guy I was surprised. Obviously they were not getting the numbers from the Administration so I started looking for details how they came up with their number and what is so important with the 7 million number?

My best guess is that the 7 million number was an arbitrary goal set up by the Administration last year that they thought would indicate an approximate health of the Affordable Care Act(ACA) process and in particular the viability of the exchanges. I don’t think anyone put much thought into the 7 million number. It has always been more of a political goal rather than an operational goal. Considering the ambiguous nature of this number I do not have a problem with the Administration celebrating this achievement since they have so few accomplishments to celebrate. Achieving this goal is something you celebrate at Happy Hour while reminding yourself that the blind pursuit of political goals breeds incompetence. If you really want the ACA to work, you have to throw your political hat into the closet and put on your manager hat . It is time to start managing for success and the road to success starts with effective goal management. If we recognize that the people who signed up for Medicaid is a separate and distinct issue from the issues affecting the viability of the exchange then we can see why FBN  focused on the new, paying enrollees who were previously uninsured. There lies the difference. FBN has the manger hat on and the Administration still has the political hat on and the goal posts have vanished. Obviously the number of new, paying enrollees who were previously uninsured is probably a more important to the health of the individual health insurance market than the Administration’s number of enrollees. It was hoped that the demographics of the new enrollees  would be dominated by healthy millennials to assure the viability of the market. Although it will probably take several months before we get a report on the demographics, Fox and others can and should start making initial assessments based on the information that is available. If FBN’s report of a about a million new, paying enrollees is correct then we probably have too few new people in the market regardless of the demographics. If exchanges are going down a path that looks like a lot like a slow motion death spiral, maybe it is a good time to start looking at a different way to pay for pre-exisiting conditions before it actually becomes a death spiral.