More than 8 million Healthcare.gov enrollees with subsidies can't be wrong unless the U.S. Supreme Court says so.
When President Barack Obama signed the Affordable Care Act into law in March 2010, the expected court challenges were already percolating. But few suspected that the subsidies for exchange enrollees would come down to a few words in 900 pages of law. Three years after a legal challenge threatened its constitutionality and existence, the health reform law faces a threat nearly as big and just as just as likely to unravel if the U.S. Supreme Court sides with the plaintiffs.
Ironically, the federal exchange has evolved from the ACA rollout's top catastrophe to its biggest success. Healthcare.gov was never intended to host more than three dozen state exchanges. HHS hoped that the ability to operate their exchanges would sway states hostile to the ACA. With the exception of Idaho, it didn't. The hands-off approach left Healthcare.gov holding the bag.
Despite hosting so many exchanges, there was palpable disbelief in October 2013 at how badly the administration and Department of Health and Human Services botched the rollout. The signature piece of the ACA debuted with a thud and an error message.
Two months and one major technology overhaul later, Healthcare.gov sang a different, steady tune. In 2015 open enrollment, the technology behind Healthcare.gov barely made a peep aside from some minor glitches. One platform ran exchanges for 37 states (including six partnership exchanges and two state-run exchanges that switched over) and suffered only minor hiccups.
Several state-run exchanges are questioning future viability as enrollment has not hit thresholds necessary to fund operations. Oregon mercifully pulled the plug on its failed CoverOregon platform and transitioned to Healthcare.gov. Connect for Health Colorado faces a deep-dive audit and questions continue mount over Minnesota's MNSure. There are many successful state exchanges, Connecticut, Kentucky, New York and Idaho, to name a few. But the smooth operations of Healthcare.gov and expense of switching versus revamping a state-run exchange make it an enticing prospect in states where troubles remain.
Let that sink in for a second, more states want to drop their own platforms and let Healthcare.gov host their exchange. That's not a development anyone would have predicted before Healthcare.gov redeemed itself.
Enrollment patterns also indicate success. In 2015, Florida surpassed California as the state with the highest exchange enrollment (the Miami metro area alone has more exchange lives than all but three states). Fourteen Healthcare.gov states exceeded 200,000 plan selections (final enrollment isn't available until enrollees have paid premiums or not). States that restricted exchange navigators and prevented state government from doing anything ACA-related still grew enrollment. Florida and Texas exceeded 1 million lives, while Georgia and North Carolina both passed 500,000 lives in 2015.
All of this Healthcare.gov success could be rendered moot, and the ACA could tumble into chaos. The administration has been cagey about backup plans, and most alternatives floated in Congress don't approach the ACA's sweeping reforms. If the ACA falls, it won't owe its collapse to faulty technology or a lack of people enrolling in plans.