Journalism in the Public Interest

Health Care Sign-Ups: This Is What Transparency Looks Like

How many people have enrolled in health plans using the new federal exchange? Er, nobody seems to have a clue.


Since the federal health insurance exchange has launched, top federal officials have told interviewers that they do not know how many people have been able to enroll using the website.

In an interview with the Associated Press on Oct. 4, President Obama said: “Well, I don’t have the numbers yet.”

Then, appearing on the Daily Show on Oct. 8, the Health and Human Services Secretary Kathleen Sebelius said she didn’t have the information either. “I can’t tell you because I don’t know.”

Some states, including California, New York and Colorado, are running their own health insurance marketplaces for their residents. But the Centers for Medicare and Medicaid Services (CMS) is handling enrollment for 30-plus states, including Texas, Georgia and Florida, which decided not to set up their own exchanges.

Federal officials have proudly proclaimed the number of visitors to the site, as in this tweet:

But they have declined numerous opportunities to provide enrollment figures. The latest example: A New York Times article on Sunday about the site’s problems included this sentence: “Neither [CMS administrator Marilyn] Tavenner nor other agency officials would answer questions about the exchange or its performance last week.”

Reporters and consumers across the country have said they are simply unable to enroll on the site. You can read about my experience.

Federal officials have said that they will release enrollment figures once a month, beginning in November.

Those interested in what transparency looks like can check the states. Some examples of those that have put out numbers:





Maryland (full of charts)




Firstly, sign up stats have to come *back* from the Insurance companies where people are, you know, actually signing up for insurance.

Secondly, the states with their own exchanges aren’t full of saboteurs trying to wreck the process; people trying to sign up on the federal exchange still have to interact with their own state’s databases to complete the sign up.

Thirdly, look at those numbers. Total unique visitors are running at about 200K per state over ten days. The federal site had more than that *simultaneously* the first hour of the first day.

The people running the federal site have been consumed with trying to keep the system running under overwhelming load, not produce pretty reports for you.

Finally, this is all about health coverage that doesn’t start until January. Check back then before you start condemning the federal exchange for ‘lack of transparency’.

BruceJ - well said!  I couldn’t agree more.

Shavondra Jones-Harper

Oct. 15, 2013, 1:27 p.m.

Speaking of transparency, nice how the author decides to bury the lede halfway through the story stating that enrollment figures will be released monthly beginning November 1.

BruceJ. Hear, hear.  I expect better from ProPublica.

Speaking of transparency, when will the administration (and the media) advise everybody that they have taken away the small business tax deduction for Company Paid Health insurance starting 1/1/2014.  IRS just released the ruling (quietly, they don’t want everybody to find out all at once and create a scandal) in September 2013.

Obama said if we liked our current plan we could keep it.  FALSE.

He said he wasn’t going to raise our taxes.  FALSE.  If we have to buy insurance with post tax dollars and pay all the cost, that’s not just a tax increase, but also a PAY CUT.

Repeal this Act of Nonsense and Stupidity and Hubris.

I’ve been against ObamaCare since it was proposed (because, by definition, insurance doesn’t make anybody healthier and doesn’t save anybody money) and I’m all about screaming about the opaqueness of government.  However, I’m also with Bruce, here.

This isn’t conspiracy.  This isn’t ineptness.  This is, to borrow someone else’s metaphor, “spooky action at a distance.”  The question is equivalent to asking Yelp how a restaurant cooks its food.

It’d be nice if there were more information, but it’s not available.

It’s true that insurance does not make anyone healthy, but if not having it prevents you from going to the doctor for preventive care and getting treatment when you are ill, then having insurance becomes a necessity.

The real story related to a lack of transparency here is how carefully avoids providing actual, hard, information on the critical details of the plans available. The real problem with isn’t that it couldn’t sustain 10,000 hits a second, or that the software was ineptly designed, written and tested. The real problem is that it doesn’t really tell people exactly what they’re premium will be and exactly what they’ll get for that. You won’t find those answers on, instead you’ll inevitably have to get on the phone with an insurance company rep because of the wide latitude given participating companies to make these plans as indecipherably complex as always. Here in NC, due to the active opposition to providing people with affordable health care by the conservative lobby here in the state, some people actually get a choice between ONLY TWO insurance companies on the exchange. I say most because there are many counties here where residents will have only ONE choice. Unsurprisingly, the estimated premiums for coverage by such an effective monopoly here are significantly above the national average. That, combined with the past bad behavior of health insurers, explains why so many people are fearful of what’s coming. It’s saddens me to know that we could have done better. People could have been given a much saner option. But those in a position to put that option in the law took it off the table, leaving us with a one-sided, fundamentally flawed, “compromise”.

OK, the feds don’t have the numbers for you to get all turned on about.  So what? I’m thinking Republican efforts to drive the country into a financial abyss or over a cliff (choose your metaphor) is the far more important story.  So, let’s stop whining and get busy tracking down the malfeasance of the real criminals in this democracy.

Poor ole North Carolina. Poor ole A.C.A. So things could be better, yes?  Yes, but given the hell that was raised by the willfully ignorant egged on by all the usual suspects about our President’s legitimacy and right to lead on anything, consider how lucky this country was to even get that lowly, compromised bit of legislation.  How long had honorable men and women fought to get ANY affordable health care legislation passed?  20? 30? 40? 50 years?  Longer?  And, surprise. surprise!  What do you know?  It isn’t perfect? 

My advice now is to stop complaining and be thankful you at least have a chance to see what is now possible so long as we can keep the walking dead’s hands off the opportunity for which your president fought so hard. 

The success of the A.C.A.will depend on your and other citizen’s determination to make things better as the system matures. Stop carping about what someone else has told you your government won’t reveal,and trust it is acting in your interest against those who want to profit from your health care.  Let your government make the decisions about what you will get for your dollar rather than suffer like sheep under the extortion imposed by private greed.  While you’re at it, demand the kind of clarity and transparency you need from your government with the ballot; remembering all the time your right to choose is not predicated solely on your self-interest.

One would think that finally and collectively, we as Americans could see the self interested tactics, political gamesmanship and false folly of criticsizing something as not being any good because it is not ideal and perfect. Since the beginning as a campaigner, the president has said we need to decide as a country where and how to reform our healthcare system which virtually everyone agrees needs reform. We did this, the supreme court of the land weighed in, the electorate weighed in ( again ), we overcame the obstructionism in place 24/7 since election day 2012, and now we have overcome an blatant attempt to bring the whole country down. Perhaps the obstructionists should revisit learning from the Pogo principal as they wollow through self imposed marginalization. For me, Senator McCain says it best when he says this was the most shameful period in his time in the senate body .... Perhaps the most shameful periodNAND ploy In the history of democratic governance ? I wonder what FDR, TR, JFK, IKE, RFK, MLK, HARRY, LBJ and Reagan as well as others would say on a day like today ?

Toni, that’s not entirely true.  Or, rather, it’s only true because of the way medical care is priced, with supply strictly controlled by a monopolistic guild.

To put this into context, let’s throw around some quick and dirty numbers.  I apologize if there are any errors, but we should be in the ballpark, here.

From a quick check, COBRA insurance is $550/month, which I assume is roughly what employers pay, ignoring subsidies.  It can’t be more than a factor of two off, at any rate.

Also quickly checking, a “family doctor” gets employed at about $100,000/year.  Again, figure a factor of two difference to account for where they live.

Multiply the COBRA rate by twelve for an annual insurance cost, and you find out that every fifteen people could plausibly hire a full-time doctor to take care of them.  Let’s assume I got both numbers at the lowest and multiply that by four, giving us sixty people.

That’d be paying for health care.  That’d be, by definition, the same price as health insurance.

I’m not saying it would be better, of course (and I believe that practice was banned—if you know anybody who’s a member of a lodge, they may have access to records from when that was normal operation and why it stopped).  I’m just saying that we get a lot less of a bang for that buck.  It costs something like ten thousand dollars for a hospital to treat a broken arm—basically tie it to a splint and give you aspirin—and treating insurance as protecting us from normal costs ignores that those costs are absolutely insane, and they have very little to do with malpractice suits.

Real reform would be to attack the monopoly, increase the supply of medical professionals, and let them compete for our business.  When the prices stabilize, I don’t care if you make people pay out of pocket, put everybody on insurance, or have the government pay for everything.

(To anybody on the government or even the AMA side who takes issue with what I’m saying, do your best to get ObamaCare to work, then.  I’ll be perfectly happy with healthy people, even if the mechanism seems engineered to keep the AMA in a position of power and insurance companies in the black for essentially doing nothing.  So definitely, prove me wrong with good results.)

Of course, that has nothing to do with the article, but I always appreciate the opportunity to vent…

This article is part of an ongoing investigation:
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