David Hogberg expects the ACA exchange enrollment number to be revised downward:
One factor that the CBO did not include was enrollees who leave the exchanges because their income
shrinks thereby qualifying them for Medicaid. The U.C. Berkeley Center for Labor Research and Education recently estimated that just under one-fifth of enrollees on Covered California would leave the exchange for Medicaid. Combined with people who left because they gained employer-based coverage, the Center found that Covered California would retain about 57.5 percent of current enrollees.
If that occurs across all exchanges, then the final enrollment number will be closer to 4.6 million. Of course, not every state is California (thank goodness), so the amount of churn due to Medicaid and employer-based coverage will vary across the nation. Yet those factors will cause the eight million figure to be revised downward as the year goes on. Each time that happens in the coming months, the media will hark back to the President’s victory dance. For a public that doesn’t much trust Obama on health care, each revision will likely erode that trust a little further.
Jaime Fuller also suggests that Democrats shouldn’t get too excited by the 8 million figure:
Despite the relatively sunny past month Obamacare supporters have had, it’s not clear that Republicans are misguided in basing their electoral futures against this one policy that has had a bit of a comeback. First, there is little correlation between a state’s approval of the Affordable Care Act and how many people signed up for health insurance in that state.
The latest polling on Affordable Care Act approval ratings were released on April 11 by Gallup. Kentucky residents have had an average Obamacare approval of 32 percent since 2010. However, the state was one of the biggest successes in signing up the uninsured. North Carolina also attracted many Obamacare sign-ups, yet average approval of the law is 38 percent. The law may continue to rack up successes, but they seem to be completely untethered to opinions of the law. This works to Republicans’ advantage.
And to further complicate things, Ezra explains how “Obamacare” doesn’t mean the same thing everywhere:
Obamacare isn’t an iPhone; it’s not a single, carefully tended experience controlled by a central authority. It’s more like the Android operating system. Obamacare powers hundreds of different health systems. Many of those systems are off to an incredible start. Others are struggling.
This is the problem with trying to say whether Obamacare is a success or a failure. The program will end up seeding many huge successes — and some painful failures. It depends on who you are, and where you live. … In California, for instance, there are 19 different regions, each with its own insurance options and prices.
Beutler is still optimistic about the ACA’s impact for Democrats this fall. Meanwhile, Drum runs through other ways to gauge the success of Obamacare:
I’d say a reduction in the uninsured of 25 million is a pretty good metric. If, by 2023, the number is substantially below that, it would be a big hit to the law’s success. Getting people covered, after all, has always been the law’s primary goal. What’s more, I’d be surprised if more states don’t expand Medicaid and get more aggressive about setting up their own exchanges by 2023. At some point, after all, Republican hysteria about Obamacare just has to burn out. (Doesn’t it?)
On health inflation, I think running below the post-WWII average is a pretty aggressive standard. That would require health care inflation of about 1 percent above overall inflation. If we manage to keep it to around 2 percent, I’d call that a reasonable result.
But my biggest issue is with the age-adjusted mortality rate. I know this is a widely popular metric to point to on both left and right, but I think it’s a terrible one. Obamacare exclusively affects those under 65, and mortality just isn’t that high in this age group. Reduced mortality is a tiny signal buried in a huge amount of noise, and I very much doubt that we’ll see any kind of clear inflection point over the next few years.
The Dish 