Health Care's March Madness: Buzzer Sounds On Exchanges Deadline

Open enrollment is over for 2014 while many questions remain open-ended. (Image courtesy of HealthCare.gov)

The fourth anniversary of the signing of the Affordable Care Act (ACA) passed on March 23 without much notice or fanfare.

Instead, all eyes were on March 31, the final deadline for buying health insurance through state and federal health care exchanges - and the day that fines for non-participation kicked in.

Supporters and opponents of the ACA are on the edge of their seats, anxious to know the outcome: Exactly how many people signed up, will they pay their premiums and for how long will they do so?

Unlike March Madness, we won't know how this dance ends for months to come. But like the NCAA tournament, the ACA has already had its share of victories and major upsets. The Victories

As a result of health care reform, the number of uninsured or under-insured Americans will be lower in 2014 than in the recent past.

By April 1, the White House estimated it was on track to reach 7 million enrollees through the state and federal exchanges. An estimated 9 million more enrolled in Medicaid.

The majority of the newly enrolled will receive subsidies to help pay for coverage. Their coverage will include free preventive screenings, which should improve their overall well-being and contribute to lower health care costs in the future.

In addition, health care reform allowed more than 3 million otherwise uninsured young adults to gain access to coverage under their parent's policy until age 26.

Another victory in government's eyes is that those with 'pre-existing conditions' - those who were unable to purchase individual insurance in the past - can no longer be denied coverage. Meanwhile, tens of thousands of women whose plans previously excluded maternity coverage can now obtain the prenatal care and delivery services they require.

And finally, individuals who once found it difficult to navigate the arcane individual health insurance market, and were frustrated by their limited options, can now go to an online exchange and select from a broad set of choices.

The 'Upsets'

For all the victories, other results have left many ACA fans upset and disappointed.

Despite the big push by supporters, it is estimated that only 15 percent of Americans eligible to enroll through the exchanges signed up.

In the 17 states that built their own exchanges, 20 percent of eligible individuals enrolled on average. Vermont led the pack at 54 percent. In contrast, the 27 states that defaulted to the federal exchange saw an average enrollment of only 12 percent.

And a mere 25 percent of individuals between 18 and 34 years of age decided to enroll, compared to the government's target of 40 percent.