Obamacare’s Enrollment Numbers Aren’t Real Enrollment Numbers

So far, the administration has
consistently refused to release information about actual health
insurance enrollment through Obamacare. But as Scott Shackford
noted,
multiple news outlets are now
reporting that, according to knowledgable sources, somewhere in
the range of 40,000 to 50,000 people have enrolled in health
insurance through Obamacare’s problem-plagued federally facilitated
exchange system,

These aren’t official numbers, although an official release is
expected sometime this week. But taken at face value, and presuming
they are accurate, they indicate that Obamacare is struggling so
far to meet its enrollment goals. An internal document released
earlier this month by Rep. Dave Camp (R-Michigan) noted that the
administration’s goal for the first month was 500,000 enrollees.
Combine the reported federal enrollments with the 49,000 people
estimated to have enrolled in state-based exchanges, and you still
have less then twenty percent of the administration’s enrollment
goal.

But these numbers shouldn’t be taken at face value. That’s
because the administration isn’t actually counting enrollments.
Instead, it’s
counting the number of people who have placed health plans in their
online shopping carts—not people who have signed up and agreed
to be billed, and certainly not people who have actually paid the
premium for the first month of coverage. It’s the equivalent of
Amazon counting a TV sold every time someone puts a TV in his or
her online shopping cart, regardless of whether or not they
actually go through the checkout process.

Now, there’s some legitimate room for debate and disagreement
about the best way to count enrollments. The best way to understand
the different methods is to look at some of the counts we’ve seen
for the District of Columbia.

According to documents made public by the Senate Finance
Committee last week, only five people had enrolled in private
insurance through the D.C. exchange.

That’s a pretty small number. But it doesn’t provide the entire
picture. What that means, as The Washington Post’s Sarah
Kliff
noted last week, is that five people have enrolled in plans and
paid an initial premium by October 21. A significantly larger
number—164 people—however, have selected plans and agreed to be
billed. They just haven’t paid their premiums yet. And an even
greater number—some 321 people—have moved to the shopping cart
stage, selecting a plan and putting it in their cart, but not
agreeing to be billed.

I’m willing to believe that the majority of those 164 people who
have picked a plan and told an insurer to send them a bill will end
up with coverage. But the federal government is trying to count
people from the much larger third category—the group that in D.C.
encompasses the 321 people who have merely picked a plan and put it
in a virtual shopping cart.

If D.C.’s numbers are relatively representative—and, granted,
it’s possible that they may not be—then the actual number of people
who have gotten to the billing stage is only about half the number
who have simply selected a plan. So it’s entirely plausible that
the actual enrollment in the federal exchanges is more like
20,000-25,000 people.

And that’s presuming that everyone who agrees to be billed
actually pays. Which is not a foregone conclusion.

As Jon Kingsdale, who ran the Massachusetts health exchange for
years and helped advise the federal government on Obamacare, wrote
in The Washington Post over the weekend, “Tracking billing
and collections was a much bigger challenge than getting our Web
site to work.” And Kingsdale
thinks the collections effort will actually be harder in the
federal system:

Enrollees are not covered until their first month’s premium is
received. In the individual insurance market, premium billing and
collection is difficult to track. Folks frequently pay late or in
weekly installments, or send too little or even too much. And when
they stop paying, they often do not notify the insurer; the company
must determine whether it is an intentional termination, an
oversight, or a lost or late payment. Unlike most of today’s 15
million direct enrollees, who pay premiums on their
own, an
estimated 27 percent of those who will be eligible for tax
credits under
the ACA do not have checking accounts. So they must use cash,
money orders or prepaid debit cards to pay their share of monthly
premiums.

Under the health-care law, premium billing and tracking will be
even tougher. There are hundreds of prices across each of the
thousands of plans in the federal marketplace. Having enrollees pay
partial premiums, and the IRS issue tax credits for the rest, means
twice as much billing. Calculating subsidies based on personal
income tax filings also creates security issues: In addition to the
problems with verifying consumers’ identities online, which have
created delays on HealthCare.gov, tens of thousands of unlicensed
“navigators” are fanning out across the country to help folks
enroll. Many of these people don’t have to submit to thorough
background checks, although they will gain access to personal
financial information. 

The point is that even by the administration’s standards, these
early enrollment figures aren’t good. And because of the
administration’s chosen counting method, it’s almost certain that
they are actually worse than they seem.