Obamacare Sign-Ups Beat January Enrollment Projections, But Total Enrollment Still Falls Short

Obamacare’s defenders seemed rather
pleased with yesterday’s enrollment figures. More than 1.1
million people signed up for private plans in January, making it
the first month to
beat early enrollment projections.

According to administration figures, 1.14 million people signed
up for private health plans through the law’s exchanges last month,
a little more than the 1.059 million that had been projected.

But overall sign up totals for private insurance, which now
stand at 3.3 million nationwide, still lag behind early enrollment
projections by about 1 million.

Even with January’s above-target sign-up count, it’s still going
to be quite difficult for the administration to meet its initial
enrollment target of 7 million people by the end of open enrollment
in March. In order to hit that target, the administration would
need to get more people to enroll over the next two months than
signed up in the first four months.

Enrollment is already slowing dramatically from its December
peak. Even with the above-target sign ups last month, January
enrollment is
down by about 49 percent from December. That pace probably
won’t pick up significantly in February, which means that whatever
enrollment surge we see in March (the final month for 2014
enrollment) will have to be quite large.

All this assumes that basically all of the “sign-ups” the
administration is reporting eventually convert into paid
enrollments. But that seems unlikely. Because most exchanges aren’t
handling or tracking premium payments themselves yet, it’s hard to
get a complete picture of how many people have paid their first
premium, which is necessary for enrollment. But insurance industry
officials and well-connected sources say that only about 70-80
percent of sign-ups have actually paid so far. And
in Washington state, which is tracking payment rates, only
about half of sign-ups have resulted in payment so far.

The health law’s supporters have taken to arguing that total
enrollment matters less than the demographic mix. (Insurance pools
need a significant proportion of younger, healthier individuals to
balance out the higher health costs of older and sicker enrollees.)
But the administration’s early targets look increasingly difficult
to meet there as well. The goal had been for about 39 percent of
sign-ups to be between the ages of 18 to 34. The latest figures
show that just 25 percent of sign ups so far fall in that age
cohort.

The administration and insurers have marketing campaigns in the
works. But they seem to be about as well planned as the rest of
Obamacare’s rollout. Early plans for door-to-door outreach were

scrapped, and Obamacare’s enrollment website is
scheduled to be down on National Youth Enrollment Day.

Still, because of the geographic segmentation of the insurance
market, a simple binary success or failure metric doesn’t fully
capture the law’s results. There are 50 different states, with 50
different insurance markets, and it’s already clear that there’s
going to be a lot of variance. Philip Klein of The Washington
Examiner
compared yesterday’s sign-up figures with projected enrollment
totals in each state, and found that 11 were beating their sign-up
estimates. But 12 states and the District of Columbia had come in
at less than 50 percent of their targets.

So at this point it looks like Obamacare will continue to limp
forward.
As Avik Roy argues at Forbes, the sign-up numbers now
suggest that although it will likely be more expensive and less
successful than advertised, it won’t simply collapse. Obamacare
continues to prove not so much that it can work, but that it can
survive.