By Jaan Sidorov, MD

Quick: If you had to chose a limited number of measures to gauge success of the Affordable Care Act, what would you choose?  Would it be the number of persons who have enrolled in healthcare.gov?

The number of persons who have paid for their insurance and have coverage?  The number of  young people with coverage?  The degree of spin used by the White House?

The U.S. House of Representatives thinks it’s an important topic.  They just passed legislation requiring weekly updates on the operation of healthcare.gov.

But here is one proposed measure that can help cut through the maze of competing claims and partisan spin:

The percent of persons with either 1) “silver” or 2) “bronze” plans who have gone two or more months without paying their insurance premium.

Why, you ask?  The silver and bronze plans, because their monthly premium is lower, will attract a disproportionate number of persons who were previously unable to afford health insurance and are now newly insured.

According to this just published JAMA article, even if their monthly premiums are fully or partially subsidized, these lower-cost insurance plans cover only up to 60% to 70% of medical expenses.That means cost sharing that can be excess of $6000 and $12,000 for individuals and families, respectively.

As these newly insured persons begin to access health care, high out-of-pocket expenses can lead to two scenarios:

1. Those with subsidized insurance will resent paying anything for a plan that stretches the very definition of “health insurance.”
2. Those with partially subsidized or unsubsidized insurance, because of their mounting bills, won’t be able to pay the premium.

Either drop-out scenario is very possible.  I’m not aware of any data that describes the normal drop-out rate in low-premium/high out of pocket health insurance plans, but that number exists somewhere.  If Obamacare has a higher than expected rate of drop-outs, that could spell trouble.  If the drop-out rate is low, things are going well.

By the way, following a few key metrics is considered a corporate best practice, and they’re often posted on an enterprise data dashboard. That is intended to help companies track real time success in achieving specified targets.  It’s arguably a best management practice and it shouldn’t be too much to expect the White House to post an ACA “healthcare” dashboard on their web site.  Why not?

Jaan Sidorov, MD, is a primary care internist and former Medical Director at Geisinger Health Plan with over 20 years experience in primary care, disease management and population-based care coordination. He shares his knowledge and insights at Disease Management Care Blog, where an earlier version of this post first appeared.