Guest Post: What Is All This "Deadline Creep" Really Telling Us?

guest post by Esther Ferington

Recently, I've been puzzling over a question: what is all this "deadline creep" really telling us? Not just about the considerable burden it's placed on Charles Gaba in continuing this website, which is obviously no joke—but also about what's happening as the ACA rolls out. We've been watching deadline creep for at least a month now. And I think it's kind of a big deal.

I'm using "deadline creep" to include not just redefining what "March 31" means (apparently, in some states, it means the end of May!)—but also proposals for the next open enrollment to last through income-tax season (here's one example from Families USA: look for idea 3), Nevada's law that requires any off-exchange enrollment to be open year round and so on. In general, "deadline creep" is anything that tends to loosen up enrollment restrictions and strict deadlines.

That means we're looking at a paradox. On the one hand, it's truly, absolutely essential to have a restricted open enrollment period with a definite end date. Otherwise, some people will wait to sign up until they get sick, reducing healthy signups and increasing big claims—that's Insurance 101. And yet... deadline creep has been getting close to zero public pushback or resistance from the insurers, the politicians, and even the exchange admins, who have had to spend money on staff and other resources well past March 31. If anything, people seem to be egging it on. How can that be?

I think the explanation is that this is not a stable, mature insurance market, like the ones that health-care analysts are used to. Instead—now that it's working—it's a multi-year gold rush of tens of millions of new customers, with market share for individual companies perhaps set for life in the process. And that makes everything different.

Insurance companies now have conflicting incentives: sure, they still need some way to keep people from waiting to sign up til they're at the ER—but they must also want to fling their doors wide open in the friendliest way to as many new customers as possible, before the flood dries up in three or four years. If you have the most popular smartphone of the moment, your biggest concern is to keep it in stock, and much mentioned in the news, and let the excitement build and never stop—not to focus too hard on observing your stores' closing times.

Politicians, of course, are generally in favor of maximum choice for constituents / voters and never like putting restrictions or limits on them. So any tweak or change that would provide more openness and new enrollment options, even on the margins, would be a plus for them. For anti-ACA people, this works just as well. Any increases in individual flexibility that they support are good examples of how the ACA is just terrible, but at least they support "fixing" it in that way.

I realize that much of this vast market expansion, which is only just getting started, was understood in advance—that's why insurers went along with the ACA. But the experience of building up to those March 31 (ish) enrollment spikes, especially after the fiasco of October and November, must have felt quite different than all the old, speculative internal spreadsheets, filled with caveats and estimates, in the run-up to the exchanges. And it's those accelerating enrollments that I think explain not only short-term, but longer term, deadline creep.

One result might be, for example, that open enrollment for next year could ultimately surprise us by running fairly long—perhaps even through April 15. The number and type of special enrollments in the "off season" could expand over the next few years, by law or regulation. Maybe there will be more off-exchange ACA options year-round in some other states, too, as in Nevada.

In other words, as the rush continues for the next few years, I'd say that any change that tends to open the doors wider to new customers is going to have more push behind it than we might have expected, and less (if any) opposition. The underlying reasons for signup schedule limitations are still there, but the very existence of "deadline creep" tells us that the balance point between strict deadlines and greater flexibility is farther toward the flexible side than we expected. (I told you I'd answer my starting question eventually!) And that seems like a welcome development to me.