An Open Letter to the Health & Human Services Department

Dear (outgoing Director) Kathleen Sebelius, (presumptive incoming Director) Sylvia Burwell, and whomever is in charge in between:

Your office is not supposed to be a political one. I, however, have the luxury of not being restricted by that fact. I'm a proud, unapologetically progressive Democrat. While I certainly have my issues with President Obama and the ACA, in general I think that it's an excellent start towards an eventual goal of a single payer healthcare system. While I'm still disapointed as to why they didn't simply drop the "65" age requirement from Medicare (perhaps phasing it in 5 years at a time...60, 55, 50 and so on, with an accompanying funding mechanism), or at the very least add a Public Option to compete with the private corporations, I do understand that the political realities at the time presumably didn't allow for either one.

Given the amazing enrollment success that the administration was able to pull off in March and April, pushing the total exchange QHP enrollment tally up to not 6 million, not 7 million but over 8 million (officially 8.02M as of 4/19; almost certainly another 100K over the next week and a half), I can't for the life of me figure out why you've decided to stop issuing your monthly reports.

Would the additional numbers be anticlimactic relative to the heady days of March and April? Of course, and by design; open enrollment is over. Qualifying Life Events and other special cases (Native American enrollments, etc) will likely bring in another 150K or so per month, perhaps bringing the total up to around 9 million even by the time the 2nd open enrollment period starts on November 15.

So, why on earth would you take something which managed to pull success (8.1M QHP enrollees!) out of the jaws of failure (the ugly website launch last October) and then turn around and try to bury it?

Now, some have suggested that you're stopping the reports because the post-April numbers won't be so flattering after all. Of course, that 9M or so number will be reduced by two factors: The 10% or so who never got around to paying their first premium (dropping the total down to perhaps 8.1 million paid), and those who leave their private QHP plan over the next 6 months due to their own Qualifying Life Events (getting a job with benefits, marrying someone who's already covered by a non-exchange plan, turning 65 and shifting over to Medicare, losing their income and dropping into Medicaid, moving out of the country or (no kind way of putting this)...dying). Others, as critics are quick to point out, may pay their first month's premium but might not follow up on that due to inability or unwillingness to keep paying each month.

How much will this reduce the "official" exchange QHP total? Beats me; estimates I've seen have ranged all over the place. Let's call it 25%. That would bring the official total down to around 6.08 million.

So, sure, that would be disappointing compared to the 8M+ number that the administration has been touting until now.

On the other hand, that would still be right in line with the CBO's revised projection number of 6 million from February. Even if it was more like a 30-35% attrition rate, there would still be an additional 5 - 8 million off-exchange QHP enrollees, 6-9 million new Medicaid/CHIP enrollees and several million more sub26ers and/or new ESI enrollees due fully or partially to various ACA provisions. And if the rest of the Republican states would stop being jackasses and expand Medicaid already, there'd be another 5 million or so people who could be added to these totals. Certainly the insurance companies don't seem unduly concerned, and all the hand-wringing about massive premium increases next year seems to be way overblown so far.

In addition, aside from the "can't/won't keep paying" crowd, none of those other reasons for leaving the exchange QHPs reflects negatively on the ACA in any way! If someone gains a job with benefits, good for them! Their exchange QHP tided them over for a few months while they improved their lot. If they age into Medicare, again, that's two different "Big Government" programs working exactly the way they're supposed to. The same holds true if their situation goes negative and they find themselves on Medicaid. And if they do happen to pass away, at least their ACA QHP gave them a fighting chance at medical care that they otherwise might not have had.

In other words, even if there is a significant amount of attrition, the administration still has plenty to be proud of with the first year's enrollment numbers. I find it difficult to believe that this is enough to cause HHS to scrap the reports.

Following up on this, others, such as ACASignups supporter Ken Kelly, have noted that since the HHS Dept. has access to how many have enrolled but not how many have dropped their enrollment, the "churn" effect will make the monthly reports pointless, since the number will always go up, never down. This is a valid point, but if that's the case, why don't you say so instead of issuing a mealy-mouthed, cryptic non-answer that doesn't satisfy anyone? Alternately, keep issuing the reports, but preface them with a LARGE, BOLD FACED DISCLAIMER which clearly states that the report only includes enrollments, not those who have dropped their enrollments. Problem solved. (Of course, the GOP will pretend that you didn't include that disclaimer, or will claim you "buried it in fine print" or somesuch nonsense, and many in the major news media will be too slow to grasp the importance of such a notice, but what else is new?)

Another possibility some have suggested is that you simply don't have the money in the budget. OK, I know the GOP has done everything they can to shrink the Federal government to the point of drowning it in a bathtub, and I'm sure these reports get pretty involved, but I also find it hard to believe that things are that tight that you can't spare a few people to put them together. As Megan McArdle put it (and yes, it's quite noteworthy that I'm quoting someone who I ripped apart about a different issue a few months ago):

Moreover, it’s hard to understand why it would stop reporting. Pulling together a report takes work, of course. But it’s not like it needs to do extensive research in order to gather much of this data; it needs to know the numbers in order to run the system.

Others have suggested that the Obama administration simply wants the ACA out of public view in general until the November election is out of the way. The reasoning is that the law is still unpopular and taking it "off the table" would somehow be helpful for Red-state Democrats. It's possible that this is the thinking, but if that's the case, it's terribly flawed.

First of all, the ACA isn't nearly as unpopular as all that. Recent polls have approval for the law sitting at around the low 40's, with opposition around the low 50's. Not great, of course, but not horrific...and, of course, a big chunk of that disapproval is from people opposing the law from the left (that is, single payer advocates who, unlike myself, don't see the ACA as enough of a first step towards what they want). As Steve Benen recently noted, given that attack ads on the ACA have overwhelmed positive ads for it by a 15:1 ratio, you'd think that approval level would be far lower (or disapproval would be far higher).

Of course, it's not just about the national polling; presumably Dems running in states openly hostile towards the ACA are feeling tremendous pressure to distance themselves from the law. However, that doesn't seem to be the case at all. They may not be embracing the law whole-heartedly, but Kay Hagen (NC), Mary Landrieu (LA) and Mark Pryor (AR) are bucking conventional wisdom and pushing hard for Medicaid expansion in their respective states...a campaign strategy option which, ironically, they wouldn't have at their disposal if Republicans in those states hadn't blocked the ACA expansion (Arkansas did expand Medicaid, sort of, using an unusual "Private Option" version, but their GOP legislature has been trying to shut off funding for that program ever since).

So...if Dems are happy with the ACA, and the insurance companies are happy with it, and the 11 million or more people who are newly insured are, presumably, reasonably happy with it...why are you blocking further monthly reports?

Whatever the reason, I hope you change your minds on this policy--or at the very least issue a clearer and more understandable rationale for it--or you're gonna see more stories like this one by ACA opponent Michael Cannon over at Forbes...who not only quotes me extensively in his piece, but actually bases the headline on my rant from yesterday:

'HHS Has Lost Their Minds': Obama Administration Nixes Reports That Track Sustainability Of ACA Exchanges

According to Politico [$], the Obama administration will stop issuing monthly reports on enrollment in ObamaCare’s health insurance Exchanges. “Without regular reports,”Politico health care reporter Kyle Cheney writes, “it will be more difficult to gauge the trajectory of enrollment during critical months leading up to the 2014 elections. It’s also unclear as of now whether monthly reports will resume during the next enrollment period, which begins in November.” Charles Gaba of ACASignUps.net calls the decision “a bad move” and “a huge mistake”

Well that's just lovely. I spent 7 months of my life doing part of your job for you (as well as that of the major national news media outlets, I might add), and I get paid back by getting quoted by a bunch of conservatives whose policies and claims I generally find anywhere from simply wrong-headed to flat-out idiotic.

Even if you reverse your position on this issue, it'll be difficult to forgive you for that one.

Sincerely,

Charles