Over $7 billion of went into creating the health law鈥檚 insurance marketplaces, and about . But some experts say it鈥檚 actually still too early to declare these markets a success or failure. So, what can we say about what the public is getting for its money?
The marketplaces, including Healthcare.gov and 14 state-run exchanges, are long-term investments. They have to work in the short-term, but also be desirable places for buyers and sellers to get together for years going forward.
This flea market in Colorado Springs, Colo., and the Obamacare exchanges are similar. They are both marketplaces where sellers display wares and shoppers browse and buy (Photo courtesy Colorado Springs Flea Market).
In that sense, they鈥檙e a lot like other marketplaces, like this flea market in Colorado Springs, Colorado. Buyers and sellers flock , because it鈥檚 an easy place for them to find each other and make deals. On a recent Saturday, Dillon Keller was looking to move some roller skates.
鈥淢y mother in law works for a roller rink,鈥� he explains, 鈥渁nd these are the ones people left behind for over a year. So, she said, 鈥榞et rid of them!鈥� 鈥�
Keller drove across town and is spending $20 for a little square of asphalt here to sell the roller skates. He could have just had a garage sale, 鈥淏ut it鈥檚 not as successful,鈥� he says. 鈥淵ou don鈥檛 have near the amount of people. For every one person at a garage sale, you probably have at least 50 out here.鈥�
The flea market does a lot to draw customers in. It has a big billboard next to its highway exit, a food court, and even hires a live band on weekends.
The exchanges are supposed to be desirable marketplaces for health insurance. It鈥檚 even the same principle behind the New York Stock Exchange, says Economist .
鈥淵ou could look at health insurance and see the same thing: Do people want to sell their policies on there? Or is it growing in magnitude? Those are sort of standard metrics of success for marketplaces, and we should apply them to [the exchanges],鈥� he says.
Eight million people showed up to buy insurance on the exchanges in the first six months. But will it be a good enough deal to bring them back? Will more insurers jump in? Holtz-Eakin says we don鈥檛 know enough yet to conclude which state鈥檚 exchanges are successful.
鈥淚 think we know the outliers, we know the big failures in Oregon and Maryland, for example. We know what appear to be the great successes in places like Kentucky, which is quite cheap and have a big fraction of people signed up. In between, it鈥檚 pretty hard to make the case we know who鈥檚 better than someone else,鈥� he says.
One way it鈥檚 tempting to figure out which states were successful is to divide the federal grants sent to the states, by the number of people the marketplaces signed up. That gives a a cost-per-customer.
But comparing states based on that is, 鈥渞eally not a meaningful calculation,鈥� says , an economist at MIT.
He says insurance exchanges are long-term investments. They should last for decades and every state that set up its own had similar up-front costs, like hiring technology companies to create their online shopping sites.
鈥淎 lot of the programming, the computer set up is the same regardless of how many people enroll. So, by that number, California is going to look better than Rhode Island,鈥� Gruber says. 鈥淚f you infer from that that California is better than Rhode Island, it鈥檚 sort of like inferring that we should never let small states do anything.鈥�
It鈥檚 also nearly impossible to compare Healthcare.gov states with those that did their own exchanges, based on the financial information the White House is releasing so far. And some states got millions or tens of millions of dollars in outside help from private donors. Even .
There鈥檚 just not enough information right now for economists like Holtz-Eakin pass judgment on the Affordable Care Act鈥檚 marketplaces. He says they鈥檙e only part of the picture of the federal health law鈥檚 success anyway.
鈥淚 think the focus on the exchanges per se is a natural fallout from Healthcare.gov melting down at the beginning,鈥� he says, 鈥渂ut it鈥檚 really not the right metric for success or failure.鈥�
Economist Jonathan Gruber agrees.
鈥淪uccess can really only be defined ultimately as a significant improvement in the well-being of the US public 鈥� uninsurance rates drop, seeing health improved, seeing bankruptcies drop.鈥�
The public won鈥檛 know whether that鈥檚 what they got for the tax money they spent on exchanges until well after this November鈥檚 elections.
Next year, though, federal grant funding for state exchanges starts running out. The challenge for these new marketplaces now is to grow on their own. Most have still only enrolled of the uninsured people in their states.
This story is part of a reporting partnership between and Kaiser Health News.