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Six signups on Obamacare Day 1? Why it's a big problem ... not a disaster (+video)

The number six is a shocker. Yet even if HealthCare.gov had been flawless, initial Obamacare enrollment was expected to be low. Still, the pace of sign-ups needs to increase dramatically if targets are to be reached.

By Staff writer / November 1, 2013

Health and Human Services Secretary Kathleen Sebelius testifies on Capitol Hill in Washington, Wednesday before the House Energy and Commerce Committee hearing on the difficulties plaguing the implementation of the Affordable Care Act.

Evan Vucci/AP

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Washington

An initial tally of Obamacare signups is in, and it’s decidedly weak: Just six people successfully enrolled on Oct. 1, the first day the public could shop for insurance under the health reform law.

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That’s according to notes from a health agency “war room,” compiled on Oct. 2 after the launch of the law’s public insurance exchanges. The notes were released by the Republican-led House Oversight Committee.

Even after all the news of problems on the enrollment website HealthCare.gov, the number six is a shocker. And things didn’t get much better on Day 2.

By the end of Oct. 2, the tally according to these war-room notes had risen only to 248 – a mere handful of the some 7 million Americans who the Congressional Budget Office (CBO) has projected will sign up for insurance using the Affordable Care Act exchanges.

What does this really mean, though?

You shouldn’t read too much into these statistics, because what counts is the site’s operation over the next few months, not the first few days. At the same time, these internal memos can hardly be viewed as reassuring. If anything, they’re serving as an initial reminder of how much better the site will need to function to get anywhere close to projected enrollments by a deadline of March 31, 2014.

To reach 7 million total sign-ups between enrollment launch and March 31, Obamacare participation must grow by about 38,000 per day. That’s obviously a different order of magnitude from 6 or even 248.

Here’s some deeper context on these two points: why to take the Day 1 and Day 2 tallies with a grain of salt, and why a big challenge still lies ahead for Obamacare enrollment.

Not as bad as it might sound

The first few days after launch were, by all accounts, the worst days for HealthCare.gov. Numerous problems emerged, but one of the biggest obstacles to customers was a problem initiating accounts using an “enterprise identity management tool” or EIDM.

A representative of the software firm providing that tool testified last week that a team had to work “around the clock” but that, by Oct. 8, error rates in this part of the website had dropped “close to zero.”

Moreover, even if the site had been running perfectly, the opening days weren’t expected to be huge ones for sign-ups. When Massachusetts launched a comparable type of insurance exchange, just 123 people signed up in the first month, according to numbers shared by the White House this week. The Massachusetts reform ended up being widely perceived as a successful implementation.

A new Christian Science Monitor/TIPP poll supports the notion that initial problems – even big ones – don’t doom Obamacare.

Some 6 in 10 Americans give the Obama administration a “D” or “F” grade for implementation of the reforms so far, according to the late-October poll. And only 42 percent feel confidence in the administration’s prediction that its website will be largely fixed by the end of November.

Yet about half of those surveyed said they think the reforms will succeed, ultimately, in the stated goal of extending affordable insurance to more Americans. And although half of Americans in the poll say they don’t like the law, the Monitor/TIPP surveys don’t show a big shift in opinion against the law since its launch.

It’s also worth noting that the enrollment numbers for those first two days could change. A spokeswoman for the Department of Health and Human Services has said these figures appear to come from meeting notes, not official counts.

The Obama administration says it will release official data on enrollments in the middle of the month. Perhaps other numbers will dribble out sooner – whether they show improvement as the calendar ticked later into October will be telling.

This is still bad news

Despite the caveats, the release of the “war room” notes is hardly encouraging news. And it comes as the government appears to be scrambling for help with the software problems – enlisting aid from tech gurus at Google and Oracle this week alongside its original contractors.

A crucial question will be what happens next. The pace of sign-ups needs to increase dramatically at some point, to approach the 7 million forecast by the current March 31 deadline for 2014 coverage.

Americans who don’t have coverage already, and don’t get insured by then – possibly using Obamacare subsidies to purchase on exchanges and possibly qualifying for Medicaid – will face a tax penalty. The fee for going uninsured is modest for most Americans in 2014 and is set to rise in subsequent years.

When averaged out, the number of enrollments on the site doesn’t need to reach 38,000 per day in order to hit the CBO forecast that 7 million Americans in 2014 will be insured via exchanges.

One reason: People can also sign up by printing out paper forms to fill out, by calling an Obamacare hotline, or by visiting in person with “navigators” (located at sites such as hospitals) to help them.

Also, more than a dozen states have their own websites for enrollment. Some 36 states, though, have Healthcare.Gov at the core of their enrollment process. About two thirds of the US population will rely on federally run exchanges for 2014.

Finally, one person can enroll on behalf of a family. So even if all the sign-ups happened online, they don’t need to total 7 million in order for that many people to become insured on the exchanges.

But again, the administration needs to get ready for a lot more website traffic ahead. HealthCare.gov will probably face surges in traffic ahead of two key deadlines: Dec. 15 (for people who want coverage to begin by Jan. 1) and March 31, the end of the “open enrollment” period.

If the traffic doesn’t materialize that could mean trouble for fulfilling a central premise behind the law: that an influx of largely healthy new enrollees will help defray insurer costs for the new enrollees who need more health-care services.

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