7 Takeaways From the New Obamacare Sign-Up Data

The Obama administration released another
round of data on Obamacare insurance sign-ups yesterday. The report
covered plans selected in both federal and state-run exchanges
through December 28. Some of the information in
the report had already been released, such as the total number
of sign ups. The report did, however, contain the first official
federal government data about the age breakdowns of those who have
signed up for plans so far. Yet even with the new information, the
report also left a lot of important questions unresolved.

Here are seven takeaways and unanswered questions from the
latest sign-up data.

1. The percentage of young people who have signed up so
far is below the administration’s target. As was expected
based on preliminary statements by insurers and some state-level
data, the percentage of young people who have signed up for private
plans in the exchanges so far is low. Administration officials have
indicated in the past that they need about 40 percent of private
plan enrollees to be between the ages of 18 and 34. Premiums paid
by that relatively health age group are needed to balance out the
costs of older, and more expensive to insure,
beneficiaries. 

But across the federal and state exchanges, just 24 percent of
enrollees so far are between the ages of 18 and 34. That’s well
below the target, and out of proportion to the overall age makeup
of the uninsured, about 40 percent of which are young adults. The
administration notes that enrollment amongst the young was up in
December, and says they expect that most young and healthy
enrollees will sign up in March, at the end of this year’s open
enrollment period. But the lower than expected enrollment amongst
the young so far isn’t a good sign, and suggests that insurers may
take a hit on plans offered in the exchanges this year. 

2. Every market is different, and some are worse off
than others. Overall, the young made up about 24 percent
of enrollees in private coverage through the exchanges. But the
percentages varied by state. In Ohio, for example, just 19 percent
of enrollees were between the ages of 18-34, while in New York, 27
percent of sign-ups were in that age group. There were also big
differences in sign up numbers. Texas, the state with the second
highest population, has recorded just 118,532 sign-ups so far,
while North Carolina has 107,778. What this suggests is that going
forward, there will be big state-by-state differences in the health
of Obamacare’s insurance markets. The exchange plans may prove
sustainable in some places, but crash and burn in others.

3. Private plan sign ups so far are widely
subsidized. Nearly 8 in 10 sign ups so far have been for
subsidized coverage, with 78 percent of plans in state-based
exchanges qualifying for financial help and 80 percent of federal
sign-ups qualifying.

4. More women are signing up for coverage than
men. About 54 percent of sign ups across both state and
federal exchanges so far are from women. Since medical insurance
tends to be more expensive for women, and the law prohibits price
discrimination based on gender, this also suggests that the
sign-ups through the end of last year were weighted toward those
with higher medical bills.

5. We still don’t know how many people have actually
paid for private coverage. All of these figures are for
people who have signed up for coverage. Some of them have paid
their first month’s premium, but some of them have not. Insurance
companies have extended payment deadlines for coverage beginning in
2014 to at least January 10, and in some cases beyond that, which
suggests that many have still yet to pay. But at some point, the
extensions will have to stop, and we’ll find out how many of those
who signed up for coverage actually paid a premium and ended up
fully enrolled.

6. We still don’t know how many Medicaid enrollees are
new and how many are simply renewing existing coverage. At
the beginning of a press call yesterday, Health and Human Services
Secretary Kathleen Sebelius touted the 3.9 million people the
federal government says enrolled in Medicaid between October and
December of last year. But some number of those people,
perhaps the large majority of them, aren’t getting coverage
because of Obamacare’s Medicaid expansion. Instead, they are
renewing existing Medicaid coverage. Federal officials say they
don’t have a breakdown of how many of those 3.9 million Medicaid
enrollees are new, and how many are just extending coverage they
already had.

7. We still don’t know how many people signing up for
private insurance were previously uninsured. Even if you
ignore payment issues and count all 2.2 million private plan
sign-ups as being enrolled, we still don’t know how many of those
people were previously covered, and how many already had some form
of health insurance. Given that Obamacare was chiefly sold as a
vehicle for expanding health coverage, that’s a pretty important
figure. Without it, we really have no idea how many previously
uninsured people have gained coverage under the law, and how many
have simply shifted to different coverage under the
exchanges.