Three weeks out from the ObamaCare enrollment deadline, the president's signature health care law is facing ever-increasing challenges which go far beyond the program's troubled exchange websites.
Raising questions whether it's a crippled law that's near impossible to implement along its mandated timetable, key elements of the act continue to unilaterally be pushed off by the administration. Lawmakers are raising concerns about the security of the ObamaCare websites, even as the many "glitches" that blocked would-be enrollees are fixed.
And at the heart of the Affordable Care Act's problems is the question of whether it will do what President Obama said -- cover a large swath of the country's 47 million uninsured.
The numbers the administration is using to tout its progress to that end are coming under the microscope. While officials say 4 million have signed up for private insurance on the exchanges so far -- still short of the unofficial 7 million goal by the end of March -- it's unclear how many of them were previously uninsured.
A new pair of studies suggests not very many, meaning Obama's target audience largely has not been reached.
A startling study by McKinsey & Co. showed that of the uninsured eligible to sign up for an ObamaCare private plan, just 10 percent said they had done so. Further, it found that just a quarter of those who did sign up for coverage in the marketplaces were previously uninsured. That suggests the bulk of those signing up are simply switching from one plan to another, some facing higher premiums in the process.
Further, the administration apparently has no idea how successful the program is when it comes to the core goal of signing up the uninsured. The National Journal reported that Gary Cohen, the health official at the helm of the insurance marketplaces who will soon be stepping down, said the administration is not really tracking that.
"That's not a data point that we are really collecting in any sort of systematic way," Cohen reportedly said.
Health agency spokesman Aaron Albright told Fox News on Friday that they are now "looking at a range of data sources" to figure that out.
Reports of slow sign-ups and rising premiums have only emboldened Republicans fighting against the law. Four years after its passage, the law's defeat was still the central rallying cry at the Conservative Political Action Conference in suburban Washington this week.
"When ObamaCare was debated in Congress, we screamed from the rooftops that it just wouldn't work -- that it would be a job killer; that it would absolutely make health care more expensive and less accessible for millions of Americans," Sen John Cornyn, R-Texas, said Friday at the conference. "We were accused of somehow being heartless and misinformed. But now, four years later, our predictions have come true."
The other chunk of ObamaCare-related sign-ups comes from Medicaid, which was expanded under the health care law. But while the administration recently touted that nearly 9 million were found eligible since the October launch, new estimates show just about 3 million of them were newly registered because of the health care law.
The central concern at this stage is whether the insurance industry is seeing enough sign-ups -- insurers were relying on an infusion of young and healthy customers in order to offset the cost of insuring everyone else and complying with other provisions in the law.
Without the proper mix of customers, premiums could rise. Asked about the McKinsey study, America's Health Insurance Plans spokesman Robert Zirkelbach said that what "ultimately matters" is who signs up, not necessarily how many sign up.
Meanwhile, other implementation problems threaten to exacerbate the industry's concerns.
The administration this week announced that it would let people keep plans that would otherwise be out of compliance for another two years. This was an extension of a "fix" Obama made for all those whose policies were canceled, after he was accused of misleading voters in claiming anyone who liked their health plan could keep it.
But that potentially deprives insurers of even more revenue. Insurance industry consultant Robert Laszewski reportedly said this week that insurers are "very worried" now about the sign-ups.
Hanging over all of these implementation problems is the 2014 midterm elections, and a sizeable group of Democrats nervous about the law's more unpopular provisions going into that vote.
Lead among them would be the individual mandate requiring people to buy insurance. In the latest dose of bad news, The Wall Street Journal reported that, according to the Tax Policy Center, the penalty for not buying insurance could be a lot higher than the $95 fine Americans usually hear about.
The House voted Wednesday to delay the tax penalty for one year, with more than two-dozen Democrats supporting the bill.
In another looming confrontation, House Republicans plan to tie the so-called "doc fix" to a decade-long postponement of the mandate. The "doc fix" is a semi-routine patch by Congress to prevent doctors from seeing a massive cut in their Medicare reimbursement rate. The current one runs out at the end of this month.
A spokesman for House Democratic Leader Nancy Pelosi called the GOP plan a "new low."
