Is the tide finally turning for Obamacare? After a slow start, the President’s signature policy must sink or swim in the new year

After early technical issues that gave ammunition to right-wing critics, enrollments for the medical insurance have surged in December - but will it continue?

President Barack Obama, with Michelle Obama, listens to women's concerns about the Affordable Care Act, known as 'Obamacare' (Mike Theiler/Reuters)

More than 1.1 million Americans have signed up for medical insurance via the online Obamacare healthcare exchange since it was rolled out in October, with nearly a million enrolling in December alone after officials resolved the technical glitches and processing errors that marred the new system at its launch. Taken together with estimates of enrolments via websites set up by individual states, the figures from the federally run exchange suggest that some 2 million Americans registered for insurance under President Barack Obama’s new healthcare law.

The December surge – 975,000 people enrolled via the federal website in between December 1 and 24, according to data released over the weekend – suggests that the tide might finally be turning in favour of the new system, which fell prey to embarrassing technical bugs in October. The vast majority of recent enrolments came in the days before last week’s deadline to get coverage next month.

The momentum is in stark contrast to the slow take-up and technical issues in the early days. Such were the problems that the President’s top health policy official, Kathleen Sebelius, was forced to apologise before Congress for the “miserably frustrating experience” that “way too many Americans” had when they attempted to sign up.

The glitch-riddled website also gave ammunition to right-wing critics of what is Mr Obama’s signature policy.

Now, with enrolments climbing, the administration is pushing the message that it is back on track after resolving the early issues.

“We are in the middle of a sustained, six-month open enrolment period during which we expect to see enrolment ramp up over time, much like other historic implementation efforts we’ve seen in Massachusetts and Medicare Part D,” Marilyn Tavenner, the head of the Centres for Medicare and Medicaid Services, said, referencing the healthcare law introduced by Mitt Romney when he was governor of Massachusetts, and the prescription drug benefits introduced during the presidency of George W Bush. The second initiative in particular had a tough start but, according to a poll taken last year, has grown in popularity.

Ms Tavenner said the administration had managed to fix the software issues that had plagued the Obamacare exchange earlier this year. “We met our marks on improving HealthCare.gov: the site supported 83,000 concurrent users on December 23rd alone,” she said.

As the administration progresses with the new healthcare law, a top Republican critic of the programme conceded that the President’s reforms were taking root despite his party’s opposition. “Obamacare is a reality,” Darrell Issa, a senior Republican member of the House of Representatives from California, told NBC’s Meet the Press talk show on Sunday.

He insisted, however, that the reforms were misguided. “Unfortunately, it’s a failed programme that is taking a less-than-perfect healthcare system from the standpoint of cost and making it worse,” he said.

From the administration’s point of view, while rising sign-ups are positive, there is a long way to go before it achieves its target for 2014. Based on a prediction from the independent Congressional Budget Office, Obama officials are looking for 7 million people to enrol by the end of March. If the final figures from state-run website – in all, there are 14 state run gateways supplementing the federally run website, which serves 36 states – match the latest estimates, that would leave the administration with the task of attracting around 5 million people to sign-up for insurance under the new healthcare law by the time the current enrolment phase runs out on 31 March.

A key challenge is attracting younger people, who are generally healthier, to sign up under the reforms, and thus help in keeping overall costs low for the wider pool of users.

A near-term test for the programme will come on the first day of 2014, when those who signed up before last week’s deadline begin to draw medical benefits under the Obamacare reforms. Critics will be watching to see how the system works for Obamacare users who require medical attention in the early days of January. Problems are likely to be seized upon by Republicans and others on the right, while a smooth roll out of this next phase of the President’s reforms would help the Democrats make their case to the electorate during the mid-term elections next year.

As Mark Bertolini, the chief executive of giant insurance provider Aetna said earlier this month: “The big moment of truth is 12.01am on January 1, when a mother is standing in a pharmacy, with the baby in her arms, trying to get her script filled.”