How Many People Will End Up Enrolled Under Obamacare? We Don’t Know—and It May Be a While Before We Do

After a dropping to a
slower-than-projected pace in February, the rate of private
plan sign-ups under Obamacare appears to have picked up
significantly in March. Administration officials say that sign-up
totals hit 5 million by March 17, meaning that about 800,000 people
had signed up in the first 17 days of the month. That’s nearly as
many as the 940,000 individuals who signed up in February. There
are some indications that the number of sign-ups each day has
increased since then, although it’s hard to say by how much.

What this means is that the law is probably on track to see as
many sign-ups in March as it did in December, the month with the
highest number of sign-ups so far, and perhaps more. There were 1.8
million sign-ups in December. If March matches that number, then
we’ll end up with a
total of about 6 million sign-ups by the end of the
month—equaling the revised projection of the Congressional Budget
Office (CBO). Depending on how heavy sign-up traffic is during
is during the final few days of the month, the final number could
be somewhat higher. Relying on daily-rate calculations,
Bloomberg View‘s Megan McArdle* projects
about 6.22 million at the high end; other projections are even
higher. 

No matter what, though, it now seems likely that the final
totals will match or beat the CBO’s latest projections—at least,
that is, if you’re looking strictly at sign-ups.

The problem, as always, is that the administration’s sign-up
totals don’t give us a firm hold on how many people have actually
enrolled, because many of the people who are counted as signing up
have only selected a plan using the online system; not everyone who
has selected a plan has gone on to pay the first month’s premium.
Nor do the administration’s numbers give us any sense of how many
people who end up paid and covered stay that way in subsequent
months.

Right now, however, our understanding of how many people who
have selected a plan and then completed the enrollment process is
somewhat weak. Multiple reports from January and February suggest
that about 20 percent of sign-ups never submit a payment and don’t
end up covered.

But that’s a rough approximation based on early reporting from a
handful of insurers. It’s not systematic. We don’t know if payment
rates have increased or decreased over the last month, or if people
who select a plan in the final surge are more or less likely to
make a payment. We don’t have hard data from every insurer or
state. Mostly, what we’ve got are solid but scattered news reports
relying largely on insurance industry insiders.

So the only thing we can be reasonably sure about is that the
final enrollment rate will be significantly lower than the final
sign-up tally. It might be 20 percent lower, but it also might be
16 percent, or 22 percent. When you’re dealing with 6 million or
more sign-ups, the difference could be substantial.

How long will it be before we get all of this sorted out? No one
really knows.Solid numbers on paid enrollment at the
end of March will exist, but they may be scattered amongst the
insurers. The administration has not released any information on
paid enrollments at all so far, and it’s not even clear what’s
being collected. The Department of Health and Human Services (HHS)
has indicated they do not have that information right now, but
earlier this week, House Ways and Means Chairman Dave Camp
(R-Mich.)
accused HHS of withholding that information;
insurance industry sources have also suggested that the
administration has more information than has been revealed so far.
(If the administration does know, and has chosen to stay mum, then
that probably suggests the non-payment rate is on the higher side.)
The special extended enrollment period announced yesterday may give
the administration an excuse to hold off on collecting and
reporting final numbers even longer.

So even though we can expect to see March sign-up totals fairly
soon—and may get a milestone announcement of 6 million sign-ups in
the next few days—we still won’t know the true number of genuine
enrollments. And it may be a while before we do. 

*…who is my wife.