Why it's hard to gauge progress of health care programs

The state's health care insurance exchange, Covered California, processed 94,500 applications as of Oct. 16, roughly half of all filings reported from the 16 states (and the District of Columbia) that have their own insurance markets. The state-run systems are separate from the HealthCare.gov federal website that's been plagued with technical problems (though I understand more folks are finally getting through). The problem with the early numbers is that they lack context; a single application can represent more than one person, for example, so it's safe to assume that the 94,500 figure involves many more people. Not helping are state and federal officials who have been highly selective in what they release - no doubt because some of the metrics don't look good. As expected, clueless pundits and commentators are providing the most sensational (and often inaccurate) spins. The Washington Post's Sarah Kliff brings up another key point:

Applying for insurance and buying insurance are not the same thing. An individual could have completed an application but not yet paid a first month's premium to his or her health plan -- or that payment could still be being processed. That means we could see these numbers drop when we start talking about enrollments, if people don't actually follow through with payment.

From this week's Business Update on KPCC:

Steve Julian: Business analyst, Mark Lacter, what's your take on how well Californians are getting into the Affordable Care Act?

Mark Lacter: It's hard to get a good read, Steve, because it's hard to measure the success of what is really a new marketplace. If you're basing it on the number of unique visitors coming to the Covered California website, well, then the program clearly has attracted lots of interest - they had almost a million visitors during the first week of eligibility. But, maybe a better measure would be the number of people whose applications actually have been received by the insurance companies that are going to handle the claims. If that's your measuring stick, then the numbers have been far smaller so far. Now, it's worth pointing out that California have a higher percentage of households without insurance than other parts of the nation, and so you'd expect there to be lots of interest.

Julian: So the question, then, is how many folks turn into actual policyholders paying actual premiums each month.

Lacter: The truth is nobody knows, which is why state officials want to sign up as many people as possible in the early going when the program is getting so much attention. This is especially true for younger and healthier people who are needed to help offset the cost of caring for older and sicker people.

Julian: And, that's also why any computer glitch can be such a headache...

Lacter: That's right. Covered California did run into problems in the early going, but everybody agrees that things are going much better than the federal website, which is used by folks in states that don't have their own program to oversee the health care laws. That federal site has been an utter disaster. So, by comparison, California is ahead of the game.

Julian: It's a work in progress, even here.

Lacter: Very much so. The California website still doesn't have a way for enrollees to find out which doctors and hospitals are included in each health plan. And, that's a big deal because insurance companies are limiting the options available as a way of keeping premiums low. So, it's possible that the doctor you had been using for your individual insurance plan will not be on the list of doctors that can be used for one of the cheaper plans. Of course, for someone who doesn't have any health coverage, none of that is likely to matter.