In September 2013, the month
before Obamacare’s health insurance exchanges launched, Health and
Human Services Secretary Kathleen Sebelius was asked by NBC News
what success would look like for Obamacare. “Success,” she responded, “would
look like at least 7 million people signing up for coverage by the
end of March,” the final month of open enrollment for the health
law’s first year.
But based on the administration’s report this afternoon that
just 4.2 million people had signed up for coverage by the end of
February, that goal now looks all but impossible to reach. With
open enrollment ending in just a few weeks, there’s not much time
left to make up the distance. Indeed, even if there’s a
significant, unprecedented sign-up spike in the final month, the
administration is still likely to significantly undershoot its
target.
We’ll find out soon enough. In the meantime, here are the key
takeaways from today’s enrollment report.
The administration is still well behind its initial
enrollment target—which now seems out of reach. Even with
relatively steady sign-ups through January and February, the pace
hasn’t picked up enough after the slow opening. The administration
is counting on a spike in March to make up lost ground, but it’s
going to have to be really big to even come close. About 1.78
million people signed up for coverage in December, the month with
the highest number of sign-ups so far. The administration needs a
63 percent increase from that month’s turnout to get the 2.8
million sign-ups necessary to reach 7 million by the end of
March.
The administration is still counting sign-ups, not
enrollments—so the real number of paid enrollments is substantially
lower. The monthly “enrollment” reports released by the
administration don’t actually count enrollments. Instead, they
count people who have “picked a plan” within the exchange system.
But multiple reports from insurers suggest that about 20 percent of
people who sign up aren’t paying their first month’s premium, and
thus aren’t enrolled. Other reports suggest a further attrition
through non-payment of around 2 to 5 percent in the second month.
What this means is that whatever the final number of sign ups is,
the true number of enrollments will be significantly smaller.
The percentage of young adults signing up isn’t
increasing. When it started to become likely that the
administration wouldn’t meet its enrollment goals for the year, the
White House changed the definition of success, arguing instead that
what was really important was getting a healthy demographic mix of
enrollees, with around 39 percent of enrollments coming from young
adults aged 18-34. In December, the administration, along with
other supporters of the law, pointed hopefully toward the
increasing number of young adults as a sign that the demographic
mix might work out. But the percentage of young adults who’ve
picked plans has barely budged since then. At the end of December,
24 percent of sign-ups were between 18 and 34; now, at the end of
February, it’s still holding at 25 percent.
California still leads the way. Of the 4.2
million people who’ve signed up for coverage, 868,936 are from
sunny California. No other state even comes close; the next highest
sign-up totals come from Texas (295,025) and New York
(244,618).
There are large disparities between the states.
In contrast to states like California, states with broken
exchanges, like Hawaii and Massachusetts, still have tiny sign-up
totals. Massachusetts has signed up just 12,965 people for
coverage. Hawaii has signed up 4,661.
The vast majority of people signing up for coverage are
eligible for subsidies. The administration reports that 83
percent of those who’ve picked plans qualify for the health law’s
tax credits to purchase insurance—a figure that has risen slightly
over the last few months.
More women are signing up than men. Of the 4.2
million people who have picked plans so far, 55 percent are women
and 45 percent are men. That makes sense since the law prohibits
differential pricing based on gender. But it also suggests that the
risk pools in the exchanges will be weighted toward people who are
generally more expensive to insure.
This doesn’t tell us how many uninsured people have
gained coverage under the law. Even if we knew how many of
the sign ups were paid enrollments, that would not tell us how many
previously uninsured people were gaining coverage thanks to the
law. Survey data suggests that the number is much smaller than the
overall sign-up totals, perhaps just a quarter of all people
signing up for coverage. But the bottom line is that we just don’t
know, because the administration is not systematically tracking
that data.
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