How this web designer became the Nate Silver of healthcare reporting
Back in 2013, the Obama Administration rolled out a new version of Healthcare.gov, with disastrous results. It was the public unveiling of the Obamacare exchanges that would allow anyone to buy health insurance on the open market, and yet the website was almost impossible to navigate without encountering errors that would prevent you from signing up for insurance.
At the time, Charles Gaba was running a freelance web designer business in Michigan and writing for the liberal blog Daily Kos during his free time. Frustrated by the botched rollout and the amount of misinformation floating around about how many people had actually enrolled in the exchanges, he made a public call to other Daily Kos bloggers to help him count the number of Obamacare enrollees.
That project eventually evolved into ACAsignups.net, a standalone blog that eventually captured the attention of policymakers, journalists, and anyone interested in the state of U.S. healthcare. Traffic to his blog exploded, and he became an overnight celebrity in the healthcare space.
I interviewed Gaba about how he’s monetizing his website and the role he’s played in helping save Obamacare from GOP sabotage.
To listen to the interview, subscribe to The Business of Content on your favorite podcast player, or you can play the YouTube video below. If you scroll down you’ll also find a transcript of the interview.
A transcript is below.
Simon Owens: Hey Charles, thanks for joining us.
Charles Gaba: Thanks for having me.
The reason I brought you on and why I find you to be a really fascinating figure is that you basically had this career, and still do, in website design and creating websites. Virtually almost overnight you became this one-man media powerhouse on this one specific, niche subject, that, while niche, takes up a huge part of the economy. You became this huge influential media figure. That thing is obviously healthcare. I’d love to jump right into it. Take me back a little bit to the early days of Obamacare. What were you doing from a career standpoint, and how did you suddenly find yourself getting obsessed with the Affordable Care Act where you decided to launch a blog about it.
Basically, up until the point that the exchanges launched in October 2013, I was interested, of course, as a political activist and as a website developer I was interested from a technical perspective, with healthcare.gov and these various healthcare exchange websites.
Right, because that was a huge part. If people remember, the building of the healthcare.gov was a huge catastrophe for the Obama Administration because it was this project that cost hundreds of millions of dollars and they had several years to prepare for its launch, and then on the first day, only a handful of people were able to get plans on it.
So basically, when they launched on October 1, 2013, there were two big stories in healthcare. That was one, the massive breakdown, or failure, of the federal website. The other one of course was the political side, Ted Cruz was leading the way for the government shutdown over the ACA. And those were the two competing stories, or narratives on the issue. I watched, as everyone else did, with my jaw dropped with the terrible technical problems they had at launch on the federal exchange, as well as a lot of the — at the time I think 16 states were running their own exchange websites. That’s down to 12 now, but at the time it was 16. And at the time half were having their own various technical problems as well. The other half seemed to be doing pretty well out of the gate. But yeah, the big story was healthcare.gov, which was responsible for three dozen states, and they were having horrible problems. Nobody could get through. It was crashing. Etc. Etc.
It was about two weeks into that, around October 11 or so. I was a regular blogger. I was a website developer, but I did blog over at Daily Kos.
Which is the left leaning liberal blog.
And I had been posting a series of blog entries about how things were going. And I think it was around the 11th where I posted, you know what, regardless of all these problems, the government should be releasing the data, or how many people signed up. After all this fuss, all this bother, all this gnashing of teeth, it’d be nice to know how many people are actually signing up for this thing. And that was the seed of it. That was the point where I decided that, you know what, I didn’t see any hard data from any media sources, I decided I was going to try to give it a shot myself. And this was supposed to be a nerdy hobby thing. It wasn’t supposed to be a big deal. I basically threw up a Google Docs spreadsheet, and I just started crowdsourcing for the data. And that’s how the whole thing started.
So it starts off as this Daily Kos diary. You’re combing through individual press releases from state administrators, insurance administrators, anything that would give you any kind of inkling of how many people in any particular state had signed up for either the healthcare exchanges or Medicaid. From what I remember, because you weren’t an expert in these issues, there were a few fumbles and starts where you were double counting some people. You had maybe a few people from Daily Kos who were taking their own states to watch and pitching in at first.
The original idea was, because I had been blogging over at Daily Kos for quite a long time, and I had a little bit of a following over there, so people read my stuff. And so what I did was put out an open call. And my original idea was to get 49 people to each adopt one state. Hopefully their home state. So the idea was that someone in Wyoming would keep an eye on Wyoming, and any time they saw some data, some headlines from the insurance department, they would send me the link. And I would check it out, and if it was accurate information, I would just plug that in.
That was the original idea. It sort of worked out that way. There were about 15, 20 people who were helping out at first. Several of them ended up taking on several states. And then I would take on what nobody else would. And it sort of worked like that for a while. I did make a lot of mistakes early on. Stuff like, let’s say there was a number saying 30,000 people signed up. I didn’t know, depending on how the article was written, or my interpretation of it, it was hard to tell sometimes whether it was referring to the number of people, or the number of policies. You could have a family of three, but it would only count as one policy. That sort of thing.
And yeah, sometimes I was mixing up individual policy enrollments with Medicaid enrollments. And that wasn’t so much me, so much as a lot of the news reports were very confused very on. Sometimes the reporter didn’t know or sometimes the person they were quoting was sort of mushing the two together. The first few weeks it was a little chaotic. It appeared to be the best that anyone seemed to have come up with. Because that was when people started paying attention, and using my data as a little bit of guidelie.
You were probably pretty obscure at first, only known to Daily Kos community. You eventually transitioned from Daily Kos to launching a website at ACAsignups.net, which at first was just a spreadsheet with updated numbers. But you eventually transformed it into a blog. Tell me about when you went from being kind of obscure and only known by a small community to where all of a sudden you were being cited and closely followed by some of the most influential healthcare reporters and members of the Obama Administration. There was one great anecdote you told me about where you woke up one morning and received a text saying that your name was mentioned on MSNBC.
Yeah, that was around, I’d say mid December. That was the point when it was about six weeks in, for the first open enrollment period. The worst of the technical problems had been worked out. At healthcare.gov. It was still having some issues, but it wasn’t crashing. People were able to log in. They were able to enroll. The enrollments, there was a massive surge. The total enrollment period would last six months. But if you wanted your coverage to start by January 1, then you had to enroll by December 15th. They eventually extended the deadline. So the site was working. People were enrolling. They were trying to get in before the deadline.
Up until that point I had a couple mentions here or there in a few other blogs. But it was really around that point that there were two well known reporters, Dan Diamond and Sarah Kliff. Dan Diamond is with Politico now, but at the time he was with some kind of healthcare organization. I think it was called the Advocacy Group.
I think he was writing at Forbes at the time.
Right, he also wrote for Forbes. He wrote a piece at Forbes that made a mention of my site. And that same week, Sarah Kliff, who was at the time at the Washington Post, she would later leave to start Vox.com with Ezra Klein. She wrote a piece at the Washington Post that was basically a profile of my work and the graphing I had been doing of all the numbers and such. I didn’t know anything about it beforehand. All of a sudden I started getting a bunch of traffic to the site, and she made a mention of me on Twitter, saying if you aren’t following Charles Gaba for healthcare stuff, you should. And all of a sudden my Twitter following just started exploding from 100 followers to a couple thousand within a couple hours. That was the piece that got people’s attention.
After that, it was just nuts. Because the open enrollment period was closing and all of a sudden I had gotten my big media mention. From that forward I started getting mentions in all kinds of healthcare articles, and then basically political writers who were writing about the ACA and the political implications.
The story you were referring to. That was actually on the morning of December 31. The Obama administration had sent out all their advocates and spokespeople to the various outlets saying starting tomorrow…because January 1 was the day the actual new regulated policies to go into effect. That was also the day that Medicaid enrollees, their coverage went into effect. That was a big deal. They were sending out all their people to say a new day in healthcare starts tomorrow. And yeah, there was a guy on MSNBC. He was like a White House healthcare advisor. He was doing an interview. And they were pushing him about the numbers, saying that’s all well and good, but what about the numbers? And he hemmed and hawed because they didn’t have the hard numbers. And he said, well I can’t give you the official numbers, but there’s this guy, Charles Gaba, and he says…
I got a text from a friend of mine who was like dude, I just heard your name mentioned on MSNBC, and I was like what?
The reason I find your story fascinating is because the kind of evolution over time where you started out with someone with a mild curiosity in something and then you started to write about it, and then you just became more and more knowledgeable about it. It’s almost the classic arc of the beat reporter as they get more knowledgeable, they become more confident, they know what questions to start asking. And then they become better at it. So you look at the early history of your blog, where it was becoming just a recording of numbers, and then it became something more robust. You went from being simply reactive to almost being a forecaster. So, at some point you started making predictions about the numbers that were going to hit, and almost had like a Nate Silver moment, where you hit this huge number almost right on the head, and everyone was bowed by the fact that you had predicted these enrollment numbers so well.
Yeah, that started in January and February of 2014. That was where that hit its peak. I had taken, I’m not a statistician. I don’t have access to these tools for predictive analysis. But I was basically looking at the trend line. And I took some educated guesses about where I thought the numbers would be coming in each month. And it became a little game I was playing with some online friends of mine. As it happened, the end of January, I had predicted 3.3 million people would have signed up at that point. And as it happened, the precise number when it was reported a few weeks later. It turned out to be 3,299,900. I was off like a thousandth of a percent. That was when people were like, oh, he’s the Nate Silver of Obamacare. But, to be honest, I’ve actually gotten worse. The first year I was dead on accurate when I didn’t know what I was doing. Now that I do know what I’m doing, I’ve gotten worse each year since then. Make of it what you will. But also it’s become a little less important. My original, the graph that I started out with, that first year, the big magic number was 7 million.
So just to remind listeners, there was an open enrollment periods. The first open enrollment period, there was this question of, when the first open enrollment period ended, how successful was the first year in terms of actual enrollments? Conservatives were claiming that nobody was actually signing up for the exchanges. That it was actually going to be a net loss in terms of new people getting insurance. So there was all this drama over what that final number would be. So you were kind of at the heart of that, because you were the one who was actually trying to track the numbers.
Yeah, anyone who remembers, it was a big, big deal. The thing was, the 7 million number, that was not….basically what had happened is the CBO had issued, they would have to know how much the federal government would have to give out in subsidies. In actual help. They just need to have some sort of rough guideline of if this many people enroll, we’ll need this much money, this many billions of dollars or whatever, for the budget. So they had issued a report a year earlier back in early 2013 where they said that somewhere around 7 million people would probably enroll in the first open enrollment period. They weren’t saying that this was do or die. That if this doesn’t happen the earth would open up and swallow the country. They were just saying it’ll probably be around 7 million. And then just before the open enrollment period that Fall, Kathleen Sebelius, the HHS secretary, she had given an interview, and the reporter had asked her what do you define as success? And her response was we think success is 7 million people enrolling by March 31. And the media took that ball, they ran with it. And all of a sudden it became, if they don’t hit 7 million, then we’re all dead. Then it became that all important number.
And the reality is that it certainly was better to get more enrolled than fewer, but it’s really more about the risk pool. If you have 7 million very sick people enrolling and nobody who’s healthy enrolling, then that’s worse than 5 million where you have a good mix.
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So there’s a lot of anticipation. We’re getting up to the date where the enrollment period is closing. Tell us about what was happening to the traffic to your blog during that time.
It started going nuts. It was toward the end of March. And as that approached, the last two weeks of March, traffic went through the roof. I went from getting 1,000 or 2,000 visitors a day to getting 20 or 30,000 a day. Which for me was a big deal. And I was getting mentions all over the place. I was doing interviews left and right. I was on NPR a couple times. Rolling Stone. Newsweek. Paul Krugman of the New York Times, he gave me a couple nice shoutouts. And it was a few days before the end of March that they were giving a two week overtime period. It wasn’t a full extension. If you had started the process by midnight on the 31 you were allowed to be given the next two weeks to finish it up.
The last two weeks of March and the first two weeks of April, it was sheer insanity for me. I was doing eight or nine interviews a week. And I was working 16 hours a day keeping it updated.
And meanwhile your web design business is kind of failing at that point because you’re not really making a lot of money on the blog, and all your paying clients are like oh, it’s great you’re on TV, but what the hell is that doing for me?
Yeah. I had started accepting donations on the site a couple months earlier. But I was really super humble about it. I actually put out a poll asking if it was appropriate for me or not. Is it OK for me ethically to ask people to give me a hand. So I threw a little Paypal link on there, and people were donating a few bucks here and there. I appreciated it. It was a fairly low key thing.
At the same time I was losing business. I did lose several clients over it. And I don’t blame them, I understand. At this point my wife who had a background in IT. She stepped in and started helping me out, trying to unburden some of the load so we didn’t lose any more clients.
So you had this huge crescendo of traffic. The day comes and goes. And you could have ended the blog right then and there. In fact you were planning to. But then you kept it going and kind of transitioned, and became something even more robust than just counting numbers. You started to become an expert in all aspects of healthcare, especially relating to insurance. And you became this incredibly valuable voice with analysis. But it wasn’t just with the blog. You also started ramping up with your Twitter account. And this is when Twitter started allowing you to upload native images to Twitter. Threaded tweets. And you just became this kind of explanatory force where you were diving really deep into really arcane details. You became a realtime fact checker on what were incredibly ridiculous claims that were ongoing from Republicans during that time.
I was originally planning on, it was supposed to be an idle hobby. I never planned on doing it past the first open enrollment period. March 31 would come and go. Here’s the final numbers, and I would shut it down. By that point, I received so much attention. And I had a whole bunch of people begging me to keep it going.
I was fortunate that the good folks at Daily Kos, they put together a little fundraiser for me. And they raised enough money, which I’m very, very grateful for, to basically cover my business losses and keep me going for a second year.
Yeah, they raised like $40,000?
I think it was $50,000. It was a substantial amount. They asked me, hey, we’re thinking of doing this fundraiser. And I figured it’d be a couple thousand dollars, and that would be very nice. So that inspired me to keep it going for a second year.
By that point, I hadn’t really started the blog until January or so. Before that it was just a spreadsheet. And then I started moving my blog posts from Daily Kos over to ACAsignups. And I started dipping my toe into actual policy analysis. Not just how many people are signing up, but here’s why I think this state is doing better than that state. And that sort of thing. I started learning more and more about how it all works. A lot of this I got from other people. There’s an endless of people on Twitter who have actual expertise in health insurance, and actuarial sciences. They were teaching me. I was learning from them. What all the stuff means and how it all interacts with each other. I tried to keep it fairly non political up until May or June, a few months after the enrollment period ended. I was trying to be here’s just the facts. It was at that point the 2014 midterm attack ads came out. The Koch brothers and Americans for Prosperity. They started running all these ads. And a lot of these ads had ridiculous claims. And there were a lot of pundits online. And so that was the point where I started getting a little more political about it.
Really fascinating is what happened as the 2016 elections came into play and Trump won. And then all of a sudden it became about tracking the success of Obamacare to defending it. And so you’ve become this kind of quasi reporter slash activist. Especially right now. We’ve had a lot of GOP sabotage against the law. The Trump administration is no longer paying the CSR subsidies for the insurance companies. They removed the individual mandate. All kinds of things that are drastically driving up healthcare premiums. And you are tirelessly, methodologically going through every state and congressional district, cataloging state by state how much the Trump/GOP sabotage is raising the rates. How much impact have you seen as a result of that in terms of utilizing of what we talk about when we say “the resistance,” getting them to attack GOP members in town halls and campaign ads?
Every year, for three or four years, I’d say I’m going to do it for one more year, and then I’m going to stop. The second year was the Daily Kos folks helping. For the third and fourth years, there were a lot of individual donors chipping in. And I do have some banner ads on the site. I’ve had an ongoing arrangement with the Robert Wood Johnson Foundation. They have a banner ad on the site, which helped out as well. That got me through the next couple years.
But each year I was like, this is the last year, I need to get back to my business. And it just, for one reason or another, I was able to keep it going. Thanks to these folks and organizations helping out. And then 2016 was going to be my last year. And my reasoning was that if Hillary Clinton won the election in 2016, then I’d see it through to that open enrollment period. And then I was going to quietly wind it down. I figured I’d leave it up as an archive. I figured that if she won, there wouldn’t be, I mean, by that point, four years in, traffic to the site had started to drop off, and there wasn’t any in the moment, realtime need to know exactly what was going on. There was still all sorts of healthcare stuff, but I figured it’d die down and become part of the national zeitgeist. Nobody’s breathlessly, the social security numbers and Medicare enrollments, there are government agencies that track that stuff, but you don’t have people breathlessly tracking it every moment. So I figured I’d wind it down and focus on my business.
Well, then of course we know what happened. Instead, Trump ends up being elected. And there was a panic. I was planning on shutting it down right then. I actually changed the name of the site. I actually registered ACAsignoffs.net. I had a logo with a big red cross through it. Within an hour of doing that I had a dozen people emailing me saying no, no, no, you have to keep it going. We need you more than ever now.
And so, I changed it back, and I kept it going. The mission of the site shifted. I still track the enrollments. But last year it became more about the sense of urgency and protecting it. It went from here’s how many people signed up to here’s how many people could lose their coverage if this repeal plan goes through. That repeal plan goes through. If he cuts off the CSR funding. The granular data, the county and congressional district stuff. I started doing that on my own, posting a state by state, here’s how many people I estimated would lose Medicaid, would lose private plans. I was doing it with my limited capabilities. Shortly after that, the Center for American Progress, a much larger organization with greater resources, they started doing more of a deep dive into it. They broke it out at the Congressional district level. County level is easy for me because that information is easy to get a hold of. But congressional level is hard because of gerrymandering, you could have one district that winds through nine different counties. They had access to all sorts of data and mushed it all together. And they wrote up these analysis that broke it out.
What I did, I took their data, because they had done the hard work, and I reformatted it into more of a user friendly, color coded infographics. Making sure to give them credit. And I posted those to Twitter and those got a lot of attention.
Because people started tagging their Congress members and directly tying their vote to the number of people who were losing insurance.
That’s the thing. It’s one thing to say, depending on which version you were talking about, 20 million, 22 million, 32 million. All these tens of millions of people who were at risk of losing coverage. A big number like that, it sort of tends to … people’s eyes glaze over. When you say here’s how many in your state, or here’s how many in your county, or how many in your Congressional district. You drill down, the more you make it personal. It’d be great if you get here’s how many in your neighborhood. The more you can personalize it, the more those numbers mean. Especially if you’re one of those people. So that got a lot of attention a lot of retweets.References and such. I don’t know how much of anything of an impact it had. I hope it had some.
So this podcast is called The Business of Content, and I’d be remiss if I didn’t just talk very briefly about the business part. We talked about how you had that one major partnership with Daily Kos. Raised $50,000. Over the years, you’ve had various crowdfunding. Mainly Paypal links and Gofundme. In the last year you launched a Patreon account, which allows people to subscribe on a monthly basis and get extras. How is that going in terms of taking your tremendous online influence and transferring it to make it worth you while and at least subsidize what you’re doing. Obviously this takes away from your web design business.
My wife has pretty much taken over 80 percent of the web design side of it. More formally. It has dropped dramatically, but she’s sort of shoring up. And we’re trying to rebuild what we can. That was one of the major decisions we had to make last year. I was originally planning on winding it down, and then this happened, and I had to make a decision on whether I was going to shut it down, or actually try to make it into a fulltime longterm career. And as I said, thanks to the generosity of many individuals, as well as those who have taken out ads on the site. Up until last year it was a hodgepodge. It wasn’t done as a real plan on my part. I sort of, grabbing, doing this and that. And hobbling it together. Last summer I had a long talk with my wife and decided here’s what we have to do. And I decided if I’m going to do this on a longterm consistent basis, while I very much appreciate somebody donating 10 bucks here and there. If i want to make sure this is going to be a viable, longterm consistent thing, then yeah, that’s where the Patreon became a perfect, ideal solution. Because it’s a monthly, consistent amount. It’s $5 or $10 a month instead of $100 one time. I mean I’ll take either, but it’s better to have that steady, consistent revenue stream so you can plan ahead and have an idea of whether it’s viable long term.
So far, that’s, I’d say, I’m about 20 percent of where I’d hope to be. But that gets a little tricky because it depends….in my head my ideal would be to rely fully, solely on individual donors. On a monthly recurring basis. So I launched that back in August, September last year. I have about 140 people who are regular supporters on a regular basis. You were the first I believe. So, again, I’m incredibly grateful to all of them. But I don’t know that that’s going to…I’m a portion of where I’d hope to be. But I suspect there are limits. I would need about another 700 or 800 people on top of that to make it a fully reliant career.
And I think that speaks to something that woke me up. We’re hearing about the success of subscriptions and that people are supposedly, everybody is willing to pay for content again. But it’s still a difficult market out there. Even someone like you who has tens of thousands of people following you on Twitter, who has owned a niche and built up a fan base, the fact that even you are struggling to get to the subscribers who could completely replace your income. Especially on something that’s so impactful as healthcare. Shows how difficult it can be to train people who are used to getting stuff for free that you know, it actually cost money.
Especially the first year when I was first hesitating about taking donations. Part of the reason at the time, and this was going back a few years ago, at the time, there were a lot of other people who were helping me. I was doing the crowdsourcing thing. I was just compiling their data. And it felt almost wrong to be like they did a lot of the work. But at the same time, since then there are fewer people contributing little bits of data and more of it is on our own. People still do help out. But I’ve become comfortable with that. Because at the same time, it’s taking more time in the day.
I want to stress, the folks at Daily Kos and the big fundraiser they did for me. And at the same time I do have this banner ad agreement with Robert Wood Johnson. But if you’re talking about individual donors, individual subscribers, it’s tough to get a full …. It’s a very nice supplement, and I’d love it to cover the full amount. I suspect it’s going to be difficult.
And I saw you raised another $20,000 on Gofundme.
Well that’s over a two year period. The thing about Gofundme, and again, I appreciate it, it’s a great platform. I don’t know what percentage it is, but I know that usually it’s more of a one-time, here’s so and sos house burned down. What is your goal? My goal, if I”m using Gofundme, if I want people to support me for the next 40 years? I don’t know, a couple million dollars would be nice. So I picked a number, and it’s been gradually edging up there, but it’s over a two year period, so it’s not like I got $20,000 last week.
So it’s a piecemeal thing. You’re at least subsidizing some of your income, between Paypal, Gofundme, Patreon, and some banner ads. And I think you picked up some freelance reporting for some healthcare publications. It’s a tough market out there. But it seems like you’re going to continue doing it, and hopefully you reach that point where you’ll be able to make it worth your while.
It’d be nice.
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