Less Than Half of the States Met their Obamacare Enrollment Targets

In the press release accompanying the administration’s Obamacare
enrollment report yesterday, Health and Human Services Secretary
Kathleen Sebelius declared that the 8 million people who had signed
up for private health plans in the law’s exchanges had “exceeded
expectations.” 

That depends on which expectations you’re referring to. Looked
at nationally, it’s true enough, at least if you count sign-ups
rather than paid enrollments. The Congressional Budget Office (CBO)
had initially expected 7 million people to gain private coverage
through the law in 2014, an estimate it revised down to 6 million
after the botched launch of the exchanges last of October. As of
April 19, slightly more than 8 million had signed up, according to
yesterday’s report. If you’re looking at actual enrollments, on the
other hand, and you assume a 15 to 20 percent attrition rate due to
non-payment of premiums, then the coverage total drops to somewhere
between 6 and 7 million, meaning it beat the CBO’s revised
expectations but not the initial projection.

But it’s also worth remembering that Obamacare enrollment varies
quite a bit by state. And some states beat their enrollment
projections handily, while others lagged far behind initial
estimates. An analysis
released today by the health consultancy Avalere Health compares
enrollment projections in each state with total reported sign-ups,
as well as with a lower figure that factors in a 15 point drop as a
result of non-payment of premiums. 

According to Avalere, 22 states met or exceeded enrollment
expectations, with the biggest overages appearing in Florida and
California, which even after attrition for non-payment hit 199 and
186 percent of their projected sign-ups, respectively. Another four
states came reasonably close to hitting their estimates, reaching
at least 90 percent of their projected total. Here it is in map
form: 

The rest of the states all came in lower, in some cases much
lower, than expected. Attrition-adjusted enrollment in the
Distriction of Columnia came in at 40 percent of expected
enrollment. Hawaii came in at 46 percent. Wisconsin came in at 57
percent. The figure that stands out the most is New York’s
attrition-adjusted enrollment, which is just 49 percent of the
expected total. That’s a bit unexpected considering that New York’s
existing mess of insurance regulations had
decimated the individual market, and that it was one of the few
states where Obamacare’s rules were almost certain to bring down
individual market premiums from their previous highs. (Granted, the
state still managed to sign up 370,500 people, more than all but
three other states.) 

The report is a reminder is that, especially at first, Obamacare
is going to look and feel very different depending on what state
you’re in. In some places, you’ll see robust sign-ups and insurers
responding accordingly. In other states, you’ll see tiny markets.
Health plan providers are just not going to care as much about
doing business in those areas.