The expectations game

Long-term results will be true measure of health care law

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President Obama defended his health care reform in Boston on Wednesday, rightly saying "there has been a lot of confusion and misinformation about" the law, but the administration still hasn't said how many people have enrolled in insurance through HealthCare.gov.

In a conference call with reporters ahead of the president's remarks, a White House aide dwelled on the recent history of health care reform in Massachusetts, which established a system in 2007 that served as a model for the Affordable Care Act. The "arc of enrollment" in the Bay State, the aide noted, began with only 123 sign-ups in the first month after the state's exchange opened. By the first deadline for Massachusetts residents to obtain coverage, however, 36,000 had signed up.

Translation: No one should have expected many people to enroll in the opening weeks of HealthCare.gov, and low numbers released next month would not indicate that Obamacare is failing.

Low numbers released next March — right before people will be penalized for lacking insurance — would, however, be a different story. Insurance "is a grudge buy, and so there's going to be a lot of browsing," said Jon Kingsdale, who ran the Massachusetts exchange when it opened and was on the conference call.

That's all true. But currently low enrollment figures would also be a direct result of a dysfunctional website that hasn't allowed many people to buy coverage for next year.

Negative experiences

More concerning than the raw number of people blocked from buying early, though, is that their experience will dissuade many more people from trying later, when experts assume applications will flood in. One way the national rollout is different from the Massachusetts experience is the intensity of the attention Obamacare is getting -- and was bound to get.

HealthCare.gov's technical problems are dominating U.S. politics. Millions of people had a lousy time visiting the site this month. As HealthCare.gov starts working better and hard deadlines begin to loom, perceptions about how well it and other elements of the new health care law are functioning will have to turn sharply.

So the comparison to Massachusetts is useful — up to a point. If the national experience ends up mirroring the Bay State's health care rollout, the Obama administration will have pulled it off in the face of considerably stronger head winds, some unavoidable, some self-imposed.


Stephen Stromberg is a Post editorial writer.