The Portland (Maine) Press Herald, Jan. 6, 2014
By now, we have all heard that the rollout of the Affordable Care Act was a disaster. The federal website was dysfunctional, preventing people who are now mandated to buy insurance from signing up. Millions more received notices that their policies had been discontinued because they were not compliant with the new law's requirements.
But despite the bad start, real numbers are showing that the law may be working better than we'd heard.
According to the website ACAsignups.net, there have been 2.1 million people signed up for insurance through the online exchanges, including the federal website, which covers Maine and 34 other states. That's just a fraction of the estimated 40 million Americans without insurance, but it's not all of the newly insured.
About 4.3 million people have been signed up for federally funded Medicaid in the states that expanded under the ACA. (About 5 million more people, including 70,000 in Maine, would have been eligible if their states had accepted the federal funds.)
And there are the 3.1 million people under the age of 26 who received coverage under their parents' plans. That brings the total to 9.5 million so far, well within range of the administration's goal of 10 million signups by the end of March.
It's far too early to declare victory for the ACA. There are problems with the nation's health care system that expanding insurance coverage won't fix. In some cases, it could make things worse.
A study of Oregon's Medicaid lottery experiment published last week in the journal Science found that expanding Medicaid increased the likelihood that a patient would seek care in an emergency room by 40 percent, even when their ailment is not an emergency.
The response to this data, though, shouldn't be denying people coverage so they won't seek help.
Access to primary care at night and on the weekends for people with inflexible work schedules, and public education about knowing when to go somewhere other than an emergency room are also key elements in controlling costs and making insurance premiums affordable. Maine's experiment with the accountable care organization model could play an important role in getting people the right kind of care.
But even if health care reform in the United States is far from complete, the news so far should be encouraging. Nearly 10 million people who were an illness away from financial ruin now have health insurance. Millions more will join them as other aspects of the law are phased in.
Critics of the Affordable Care Act can still find fault, but their efforts would be best directed at improving coverage, access to care and controlling costs. For nearly 10 million Americans and more on the way, there should be no going back.