CNN Political Ticker

Obamacare success not all about numbers

(CNN) - Vice President Joe Biden said what others have basically conceded - the Obama administration may fall short of its original enrollment target for Obamacare.

That might give critics another reason to attack the health care law, but the acknowledgment is consistent with what number crunchers have said previously.

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"Initially, we talked about by the end of this period having 7 million people lined up. We may not get to seven, we may get to five or six, and that's a hell of a start," Biden told a gathering during an unscheduled stop in Minneapolis.

The nonpartisan Congressional Budget Office predicted similar numbers in its latest budget outlook released earlier this month.

Due in part to numerous technical problems with the government's online insurance exchange, HealthCare.gov, CBO lowered its prediction for how many people would be enrolled in the first year from 7 million to 6 million.

But health policy expert Larry Levitt said the lower figure is unlikely to have a huge impact on the health of the law as a whole.

"The overall enrollment number is essentially an arbitrary figure that comes from CBO's original projections of what they thought the bill would do," said Levitt, a senior vice president at the independent Kaiser Family Foundation. "This 7 million projection from CBO has taken on a life of its own."

Total enrollment is certainly important if the law is to succeed in its central goal of growing the population of people with health insurance in America.

However, what's more crucial to the viability of the Affordable Care Act, Levitt explained, is the health of the people signing up, not how many of them there are.

"What's much more important in the first years is they get the right mix of enrollees so the insurance market is stable," Levitt said. "Regardless of how many people are enrolling, what matters a lot more is that they're getting healthy people as well as sick people."

The first clue as to how successful the administration's been in recruiting a diverse group of enrollees will come sometime over the summer, when insurance companies begin submitting their rates for 2015.

"When insurers set their premiums for 2014, many of them built in some padding, assuming they were going to get an older sicker pool of enrollees," Levitt said. "When they set their premiums for 2015, they'll be looking at who actually signed up compared to what they expected."

If premiums for 2015 go up, it will signal that insurance companies feel the customers who've enrolled are sicker – and thus more expensive – than expected. But if premiums stay steady or even go down, it will show that the pool of customers who signed up in 2013 and 2014 met their expectations.

The effect that lower total enrollment has on the broader goal of expanding health coverage may be a bit trickier to calculate.

Under the new law, access to insurance is not limited to the exchange. Millions of people have already been enrolled through state Medicaid offices, and countless others have purchased insurance off of the exchange, whether directly from an insurance company or through a broker or private insurance marketplace.

Later this year, population surveys will begin to provide information on how many people are still uninsured, but that data may not reflect the impact of the entire six-month open-enrollment period.

In the spring, insurance companies will begin filing quarterly reports to state regulators detailing how many people they insure, and organizations like Kaiser will aggregate that data to paint a nationwide picture.

But Levitt points out even this data may be problematic.

"We'll probably have a data brawl over these numbers for the rest of the year," Levitt said. "We'll be able to see how many more people are insured, how many fewer people are uninsured. What's not knowable is what would've happened in the absence of the Affordable Care Act."