Chris Conover's Truth Twisting on the ACA: Part One

The other day, Paul Krugman posted a short blog entry over at the New York Times in which he laid out 6 of the biggest anti-ACA attack points which have been, in his view, completely obliterated by reality:

1) "No one will sign up!"
2) "But how many have PAID????"
3) "OMG!! 5MM POLICIES CANCELLED!!!"
4) Rate Shock
5) "Not enough YOUNG INVINCIBLES to avoid a DEATH SPIRAL!"
6) "Overall healthcare costs will skyrocket!!"

In response, Chris Conover has posted a piece over at Forbes which claims to rebut Prof. Krugman point by point, basically calling him full of beans on 4 points and "generously" giving him a split decision on 2 others.

Now, I'm not going to comment on the last three of these because they really aren't my area of expertise (although I will note that even my old sparring buddy Avik Roy--also of Forbes--has flatly admitted that the "death spiral" hand-wringing was proven false...and that was way back in February).

In addition, I've already addressed the third point ("cancelled policies") in a post way back in early April, where I provided solid evidence that the "5 million" claim is vastly overstated; the number of policies actually cancelled in the end was no more than 1-2 million at most.

However, on the subject of the first two, I think I'm in a pretty good position to respond.

Point 1: No One's Gonna Sign Up!!! Conover writes:

Purported Incorrect Prediction #1: Enrollment will be very low

Let’s start by accurately characterizing the original prediction cited by Prof. Krugman. In the linked article, Michael Cannon observes: “At this point, it seems impossible for the Obama administration to meet its target of 7 million paying customers by March 31.”  In reality, only 7.1 million had enrolled by March 31: it was only by moving the goalposts by allowing enrollments through April 19 that the administration got the count up to 8 million enrollees.

More importantly, at most 89% of these were paid enrollments (see below). Thus, Mr. Cannon was quite correct: enrollments as of March 31 fell at least 11% below the 7.066 million target set by the administration itself. Prof. Krugman’s claim that “signups exceeded expectations” is false.

Actually, the Obama administration never said that they'd reach 7 million paying customers by March 31st. What the CBO said was that they estimated around 7 million paying exchange-based QHP customers in calendar year 2014. THAT was the basis for the "7 million" figure: A CBO report from May 2013 in which they were trying to give an estimate of what the impact on the national health insurance coverage rate would be by the end of the calendar year.

Well, guess what, Chris? The QHP enrollment tally has continued to grow beyond the 8.02 million in the last HHS report: There have been over 61,000 more officially documented from just a handful of state-level exchanges, most of which are still only partially updated. Simple extrapolation based on the data from the 10 states which have provided partial post-4/19 data makes it pretty clear that we're looking at a bare minimum of 200K more per month, and possibly as much as 350K or so. A reasonable extrapolation brings the total to around 8.5 million easily as of now.

By the time 11/14 rolls around (the last date which you can enroll and still have the policy start in 2013), the grand total (including unpaid enrollments; more on that below) will almost certainly be between 9.4 and 10.5 million people.

Now, to be honest, I was thinking that this might be overstating the "off season" numbers a bit, which is why I've leaned more towards the low end (200K/mo) of this range. This morning, however, I had an interesting exchange with John Graves, the Asst. Professor of Health Policy at Vanderbilt School of Medicine, who completely independently of me came up with almost the exact same high-end estimate way back in April (see updated section) using completely different methodology.

As an aside: Yes, it's true that the Obama administration did extend the enrollment period by an extra 2 weeks. What of it? The only reason for having a specific end date is to prevent people from waiting to enroll until they're sick and then signing up, thus gaming the system against the insurance companies. In this case, there were literally millions (1 million, anyway) of people scrambling to do exactly what the insurance companies wanted: Enroll in a profit-based insurance policy. Hell, in Nevada they're even moving towards scrapping the limited enrollment period altogether and going year round; as long as the insurance companies are OK with it, who gives a shit? The point is to get people to want to enroll. As long as they continue to want to do so, the cut-off date is pointless.

UPDATE: Oh for the love of God. I've heard back from Mr. Conover and he continues to insist that Mr. Cannon's "won't hit 7M paid by 3/31" and ONLY Mr. Cannon's "won't hit 7M paid by 3/31" prediction is at issue here, simply because that happens to the the one that Krugman linked to as one example of the countless claims by ACA opponents about the enrollment numbers.

So...Mazel Tov on that, I guess. Golf clap all around.

Gee, Mr. Conover, do you really want me to repost any of the hundreds of quotes, tweets, video clips, press releases and so forth vomited up by the RNC, FOX News, the Daily Caller, NewsMax, GOP members of Congress and so forth during the height of the "broken website!!" frenzy last fall where they were mocking the pathetic numbers from October and mediocre ones from November? Where they were joking about the total enrollees not filling a football stadium, etc etc? Do you really want me to do that? Is your memory that short?

Thankfully, Jonathan Cohn has already done so for me.

I'll address the "But how many have PAID???" point in Part Two.