After a December enrollment spike, more than 1 million people have chosen plans through HealthCare.gov, the once-dysfunctional federal website. About the same number have probably signed up on state-based marketplaces. And about 4 million poor Americans have enrolled in Medicaid, which is in the process of expanding.
Yet the painful truth is that, if it hadn't been for the incompetent rollout of HealthCare.gov and resistance from Republican politicians, more people would have new coverage. Two million enrollments in private plans is behind the goal of 3.3 million the Obama administration set for Jan. 1.
Though many more probably will enroll as the final deadline for 2014 coverage approaches, HealthCare.gov's disastrous introduction both foiled people from signing up early and dissuaded others from trying at all. That's on President Obama's shoulders. On Republicans' is their continuing refusal to expand Medicaid without reasonable cause in many of the states they control, leaving millions of poor Americans without access to affordable coverage.
Consequently, the overriding task is to increase enrollment, particularly among target populations. That's not only for the well-being of those who will get coverage but also because insurers need enough healthy people paying into the system to offset the costs of the sick. They based their 2014 offerings and premiums on estimates of what that balance would look like; if the estimates fail to match reality, financing the system could be a challenge. Halfway through the open-enrollment period, it's past time for a sustained publicity blitz.
Outreach can't end once people leave HealthCare.gov. As more people enter the health-care system, there will be confusion. Through all this, observers should keep calm. The Obama administration's success at tackling many of the tasks ahead won't be clear for months, once the open-enrollment period ends and more numbers start coming in.