For months all eyes have been on October 1 — the first day people can sign up for Obamacare.
But as that day approaches, many people working on the nuts and bolts of the health law are tamping down any expectations of a sign-up stampede.
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Not everyone will enroll immediately. And that, they say, is the way they want it.
Given all the worries that web sites could crash, call centers could be overwhelmed, and the federal government’s data hub could falter as it checks eligibility and subsidies, they’d rather see a slow buildup during an open enrollment season that runs through March.
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“October 1 will be an important day to raise awareness, but it is the first day of a six-month public education effort,” said Tara McGuinness, a senior White House communications adviser working on rollout of the health law.
But given the politics of Obamacare, expect a rush to judgment.
Republican opponents are going to want to declare the controversial legislation a failure, and the sooner the better. Either tepid enrollment or technical glitches will advance their argument that the law is doomed to fail. They see the White House as playing a game of lowered expectations rather than ‘fessing up to the failures.
“If I were HHS or CMS or whoever’s calling the shots over there, or the White House, I would think that would be a natural thing to do,” said Sen. Pat Roberts (R-Kan.), one of the skeptics. “Part of me believes this is Thelma and Louise about 10 miles from the Grand Canyon.”
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Democrats -from President Barack Obama on down – say that hiccups are to be expected when the switch is flipped on the new state exchanges. It’s an intricate system that requires several complex government technology systems to successfully talk to each other — and to the consumer. A modest start to enrollment may reduce any start-up strain.
“There are going to be some glitches. No doubt about it,” Obama said at a news conference last month. “There are going to be things where we say, you know what? We should have thought of that earlier, or this would work a little bit better or this needs an adjustment.”
And it could all get even more complicated if Congress doesn’t figure out how to avoid a government shutdown. That wold be because of the ongoing fight about Obamacare – and it could start the same day enrollment does, Oct. 1.
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The administration hopes to keep the glitches minimal-and to have time to repair them before Obamacare’s public image is further hurt. Alan Weil, executive director of the National Academy for State Health Policy, says “no one gets hurt” if a problem springs up in October and is fixed in November.
“October 1 is an important day but no one actually gets coverage until January 1,” Weil said. “No one’s life changes on October 1.”
Democratic supporters of the law say that 2014 enrollment shouldn’t be measured until open enrollment ends in late March. In fact, they say, it may take two or three years to really evaluate such a dramatic new program. The Congressional Budget Office has forecast gradual growth in coverage over the years.
None of this means that October 1 isn’t important— it is. The administration hopes the start of enrollment will drive a lot of attention to the law from the media and on social networks, which will encourage uninsured people to check out the new exchanges. But people are likely to mull over options, and come back to the websites and marketing materials more than once before they commit. They may not want to pay in October if they can wait until December for coverage in January.
That’s what happened when Massachusetts opened its exchange in late 2006.
Jon Kingsdale, who ran the Massachusetts exchange and is now a director at the Wakely Consulting’s Boston office, said people in that state had an average of 18 interactions – web visits, e-mails or phone calls —before they actually bought coverage.
“It’s not going to be sudden, immediate enrollment,” Kingsdale said of the Affordable Care Act. “I would expect very little enrollment in October for benefits that don’t start until January.”
In Massachusetts, about 10,000 new, subsidized enrollees signed up each month over the first 15 months. The biggest spike came in the last two months before the mandate kicked in, Kingsdale said.
Kevin Counihan, who is leading the Connecticut insurance marketplace, hopes for a similar pattern.
“October is really the first month of testing … because it’s the first month I really believe that all the elements of the federal data hub and state interfaces are going to be ready. That’s not a bad thing,” Counihan said. “It’s going to give the states and the federal government time to really tweak it.”
He expects spurts of enrollment in the first two weeks of December — closer to to the start of coverage on Jan. 1 — and toward the end of open season in March.
That’s what Mila Kofman, the executive director of the DC Health Link, anticipates. Consumer education in October — and a rush of enrollment in December.
“We want to make sure that they’re not pushed into making a quick decision,” she said.
Nevada plans to advertise in staggered phases and won’t start directing people to the exchange website until Oct. 7.
“We want to avoid the possibility of a federal data hub crash or massive use on the federal hub so we’re turning the message over to come and enroll in Nevada health link” later in October, said C.J. Bawden, a communications officer for the state exchange.
The state’s advertising now says that the health exchange is coming. But on Oct. 7, the ad messaging in the northern half of the state will change to say that it’s now time to enroll. A week later, the advertising will change in the southern part of the state – a staggered approach to further ensure that the exchange isn’t overloaded.
David S. Lopez, president and CEO of Harris Health System near Houston, Texas, says he’s hoping to get his uninsured patients matched with insurance as quickly as possible. Today, nearly two-thirds of the system’s patients pay for care themselves. But he’s looking at the long game.
“To expect we’ll be a rousing success in signing people up – no, it’s not going to happen the first month or even the first year,” Lopez said. “We have to acknowledge there is going to be a learning curve. You’ll build the momentum and we’ll eventually get there. This is going to be a work in progress.”
Jason Millman contributed to this report.
