Inside Obamacare’s 11th Hour

The numbers looked good and the people kept enrolling hours before the deadline Monday night, but the jury’s still out on whether Obama’s legislation will define his presidency.

Monday marked the end of the 2014 enrollment period for Obamacare. Four years after the Affordable Care Act passed Congress and six months after the tumultuous enrollment period began, it was at least nominally the last opportunity for consumers to get covered—or, as the Obama administration would put it, #getcovered.

But the final countdown to sign up for the ACA featured some of the tech glitches and extended deadlines that were familiar from the past few months. Earlier in March, the White House announced that it would allow those who had started shopping for health care online before March 31 to still enroll for 2014 after the deadline. However, it won’t bother to check for proof that folks started earlier, it’s being done on the honor system. As Harold Pollack, a professor at the University of Chicago put it, “If today isn't the last day, within the next couple weeks, it will be at some point, the deadline will strike.” The deadline also doesn’t apply to those who qualify for Medicaid under the Affordable Care Act and can enroll at any time.

Yet, despite the torturous path to get the deadline, Healthcare.gov, which is the federal health exchange responsible for providing insurance under Obamacare in 36 states (14 states and the District of Columbia have their own exchanges), was able to handle record traffic of over 3 million visitors and 1 million calls as of 8p.m. EST.

At the Good Success Christian Church in Northeast Washington DC, roughly 30 people came to enroll on Monday night. Ayana Porter, an employee of DCHealthlink, the District’s health exchange, said the late rush was unusually high. Porter, a church member who set up shop on a folding table in the back of the sanctuary—directly underneath a picture of Obama and across from the hot tub sized baptismal fount across the room—said this was far more than the usual trickle of about five people signing up a day during her evening shifts. She admitted there were still some problems with the website (she had to reboot her computer on Sunday and there was a brief period during the Monday where it wasn’t recognizing the usernames of those signing up), but, mostly, the roughly hourlong process was smooth…with one exception.

“Some of these folks don’t have email addresses,” she said. Porter had difficulty understanding how people lived without web access; she certainly couldn’t. Still, Porter worked them through the process. After all, many of those who came to her did so because they were uncomfortable going through the process on their own.

Of those who signed up, Porter said about 70-80 percent ended up getting their health care for free, through the Medicaid expansion. Washington DC and 26 other states have taken federal money to expand the Medicaid rolls to include people making up to 138 percent of poverty level. Twenty-four states have rejected the money though after the Supreme Court said the government couldn’t mandate that states accept the federal funding. Porter cited a 35-year-old single man who was making about $25,000 a year who was shocked and surprised to know that he qualified for the program.

Porter was virtually kvelling (a phrase that’s likely not often heard at the Good Success Christian Church) about others whom she helped, including a Hispanic man with a significant heart condition who had been struggling without insurance for years and faced repeated emergency room visits and a woman in her early 60s who had lost her insurance when her husband had to leave his government job of 30 years because of health issues, but was still too young to qualify for Medicare.

But not everyone will get their insurance through healthcare.gov. As Pollack reminded, employer provided health insurance still remains under the law. “There are many advantages to an individual company operating their own health insurance plan, if these exchanges get going,” he said. “One of the challenges they have right now, if you're an employee at IBM or some very well-respected company, you're thinking well, I like my plan a lot, why would I want to go into an exchange to get benefits?’ and actually, there are various incentives in the law and penalties to try to discourage companies from doing that, if they're already offering you benefits.” There are also private exchanges as well that operate in a somewhat similar manner to healthcare.gov but without the subsidies provided under the Affordable Care Act.

The anecdotes cited by Porter may have resonated in Northeast Washington D.C but the jury is still out on the overall success of what is the signature legislation of Obama’s two terms in office. With the late surge, the administration seems poised to hit its goal of seven million people enrolling (in addition to the millions benefiting from Medicaid expansion or those under 26 who are now able to stay on the parents’ healthcare plans.)

Related: Obamacare Is as American as the Founding Fathers

Yet those numbers don’t capture whether the ambitious government initiative will ultimately prove successful. It’s still a partisan issue for the short term. As Pollack put it, “If Jesus came down and signed up for a healthcare exchange, that wouldn't be good enough for many of the critics.” He also noted that the Obama administration still has long-term work to do on its website to further build its credibility with the public.

In Pollack’s opinion, “HHS has to raise its game in operating a really good website, and do all the blocking and tackling required on the federal exchange to make it a really excellent product from both he consumer and insurance company perspective.”

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The University of Chicago professor was still sanguine about its prospects. “Health reform is moving forward and covering millions of people and preventing millions of people from becoming uninsured. It is chipping away at the uninsured population in the United States. It's not doing it in an incredibly dramatic fashion, but it's moving forward.”