Oh yeah...it's ACA Signups 10th Anniversary!

Until October 2013, I wasn't a healthcare wonk. I wasn't an expert on the ACA specifically or health insurance in general. I didn't know my ass from a hole in the ground when it came to risk pools, cost sharing, deductibles, out of pocket caps, guaranteed issue, community rating or any of the other industry buzz words.

Hell, I didn't even know that Medicaid is the same program as California's Medi-Cal or Wisconsin's BadgerCare Plus (that's just how those states brand the program).

What I did know was that the Patient Protection & Affordable Care Act, which had been signed into law 3 1/2 years earlier, was a Big Fucking Deal®, as President Biden had put it...and I knew that the main provisions of the ACA were about to go into effect.

Ten days earlier, on the same day that the federal and state ACA exchanges had opened for business (with some of them, including the main one at HealthCare.Gov experiencing catastrophic technical failures), At the same time, Texas Senator Ted Cruz had spearheaded a federal government shutdown (sound familiar?) in protest of the new law.

Those first few weeks were pretty chaotic for the ACA, to put it mildly.

And so, on the fateful morning of October 11th, 2013, I posted the following over at Daily Kos:

OK, so, in spite of the colossal fuck-up that the Healthcare.gov site has proven to be so far (I've been one of their biggest defenders, but 10 days out, let's face it, they screwed the pooch on both traffic capacity/projections as well as the actual site coding), we're actually starting to get some real numbers on signups, and when you tally them up, here's what you have (as of Tuesday, 1 week in):

• New York: 40,000 completed
• California: 16,300 completed
• Washington: 19,400 completed
• Kentucky: 7,000
• Connecticut: 1,400
• Maryland: 300

Add those up and you get at least 84,400 people fully signed up for health insurance via the state-run exchanges in the first week. Of course, that's only in 6 states, and it's been another 3 days since then, but since these are the only official numbers that have been released so far, that's what I'm going with for now.

Now, at that rate they'd come up short (about 2.2 million by the end of the 6-month signup period), but obviously that's not how it's gonna play out. Presumably the major bugs will eventually be worked out of Healthcare.gov (they damned well better be), and most people (including myself) aren't actually even trying to sign up just yet, but are instead kicking the tires and window shopping. In fact, we already have insurance and are simply looking for better rates, so we shouldn't even be counted in the Uninsured -> Insured numbers.

Presumably there'll be a big rush to actually sign up as we approach mid-December, since that's when you have to be signed up for coverage to start in January.

So, bottom line: Healthcare.gov sucks (for now), but Obamacare in general is actually off to a decent (if shaky) start.

Seriously, though, HHS should really start releasing the official (accurate) numbers of actual signups for all 50 states (or at the very least, the 36 states that they're responsible for) on a daily--or at least, weekly--basis. I don't care if it's a pitifully small number. 100,000? 10,000? 100? 10? Even if it's in single digits, release the damned numbers. Be upfront about it. Everyone knows by now how f*** up the website is, so be honest and just give out the accurate numbers as they come in.

Besides, that'll make it all the more impressive when those numbers start to (hopefully) skyrocket over the next 2 1/2 months.

Emphasis added.

I became a bit obsessed with this issue, and so, two days later, on October 13th, I registered a couple of domain names and launched a new personal project, which I also announced over at Daily Kos:

OK, given that the HHS Dept. is not releasing any actual, official ACA/Obamacare signup numbers until a month has passed, I've decided to launch a simple website devoted to tracking the numbers as they're reported by the states running their own exchanges, as well as other reputable sources.

Here's the place to go; I'll be compiling the numbers weekly as they come in, to the best of my ability: ObamacareSignups.net

(Obviously I later changed this to ACASignups.net.)

It's obviously very crude right now, just a simple spreadsheet with a handful of numbers and a few source links (which don't even link yet). The blue states are the ones that are running their own exchanges; the rest are all run by the Federal site (Healthcare.gov), although it looks like 2 states (Idaho and New Mexico) will be moving to their own next year, and Utah has it's own site for business signups only. Interestingly, it turns out that the territories (American Samoa, Puerto Rico, etc.) aren't covered by the ACA at all.

I plan on cleaning it up this week, adding live links to the sources and the state exchanges, along with a few other odds 'n ends.

However, I'll need your help. I'd appreciate it if 15 people (one for each state exchange, plus one for D.C.) could volunteer to check the media in each of those states for the latest official (hopefully accurate) figures on how many people have actually signed up for a healthcare policy via the ACA (as opposed to just creating an account, although those numbers will be listed as well).

If you're interested in assisting, send me a private message, thanks!

The original idea was for this to be a crowdsourced project, with other people keeping an eye on most states and reporting back to me, and a couple dozen people did help out for the first few months. My naivety and ignorance of many aspects of the law were already apparent--for instance, the U.S. territories are, in fact, "covered by" the ACA, although only to a limited extent.

Anyway, the rest is history.

What was intended to be a simple 6-month data nerd hobby eventually turned into my full-time career. I went from being a freelance website developer to becoming a nationally-recognized expert on the Affordable Care Act, which has. in turn led to me being cited in numerous national media outlets and being on healthcare town hall panels with members of Congress and even eventual Michigan Governor Gretchen Whitmer. Most recently my work analyzing COVID vaccination & death rate data was included in a chapter of Dr. Peter Hotez's new book, The Deadly Rise of Anti-Science: A Scientist's Warning.

I've been helped out by more people over the years via financial support, social media promotion and otherwise than I can possibly thank. I'm also eternally grateful to the actual experts in the fields of health insurance, public health, statistical analysis, legislative text analysis and actuarial science who have let me learn as much as possible from them.

The ACA has changed my life for the better in ways I couldn't have possibly fathomed ten years ago, and I sincerely appreciate each and every person who has helped me along the way.

Here's hoping the next decade will see the ACA continue to grow and improve, pushing us ever-closer to the dream of quality, universal, affordable, comprehensive healthcare coverage for the entire U.S. population.

Thank you all. Really.

--Charles Gaba

P.S. The 2024 ACA Open Enrollment Period launches nationally on November 1st (and even sooner in some states). I'll be posting my annual Things To Remember Before You #GetCovered checklist soon!