Some Patient Protection and Affordable Care Act (PPACA) exchange system supporters are celebrating how much use of the public exchange enrollment system is growing. PPACA critics are celebrating any signs that sign-up activity is weak.
I think that’s a little like focusing on how well your favorite professional football team, which did not get into the Super Bowl, did in a pickup game against some college team in April.
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On the one hand, obsessing over the enrollment numbers is fun.
But, on the other hand, the current ups and downs in sign-up numbers have little to do with the issues that are still open for debate.
At this point, PPACA exchange system supporters have shown that tens of millions of consumers are willing to use a well-publicized website to shop for health insurance, and that those consumers are especially likely to buy the coverage, even if the website is terrible, if their share of the premiums is low.
Some consumers who would qualify for free or cheap coverage are not sure how to use the website, but it appears that a high percentage of those consumers are vague about what day of the week it is. Their lethargy is the result of general social problems, not with flaws in the idea of using an exchange to help ordinary consumers get health coverage.
Republicans who hate Democratic programs, and democratic socialists who hate the idea of private-sector involvement in health care, can find all sorts of ways to strangle the exchange system, but those efforts would just show that it’s possible for opponents of a program to cripple the program. Surprise.
Still, on the third hand, there are plenty of major open questions.
One is whether budgeters can realistically assume that many public exchange users will ever sign up for coverage on their own, even if the websites work, or whether, in the real world, typical consumers will usually talk to a live human. (Example: you). If most consumers will be talking to live human advisors, and the advisors will be the ones making the most use of the exchange websites, what does that mean for how the exchange system should be designed and funded?