The Wall Street Journal reported on Monday that between 40,000 and 50,000 uninsured Americans signed up for health care coverage in the 36 states where the federal government is running the Obamacare exchanges, offering the very first estimate of the administration’s progress in implementing the Affordable Care Act. The Department of Health and Human Services (HHS) is expected to release official figures later this week. That number “will include people who have paid for a health plan and those who simply picked a plan and put it in their online shopping cart,” the Washington Post notes.
But the initial estimate doesn’t tell the whole story about how many people are connecting to coverage. Here is what you need to know about the enrollment figures:
1. More than 500,000 have signed up for insurance overall. Avalere Health, a consulting firm tracking sign-ups, estimates that at least 440,000 people have signed up for Medicaid and another 49,000 people enrolled in coverage in 12 states and the District of Columbia that are operating their own exchanges. Significantly, that state number don’t appear to include enrollment from California, Massachusetts, or Oregon. Thus, all told, more than 529,000 have enrolled in coverage.
2. People are enrolling despite an error-ridden website. Some enrollees — particularly the younger and healthier population who does not absolutely need coverage — may be putting off enrollment given HealthCare.gov’s technical glitches or are waiting until the website is fixed to sign up. The administration reports that more visitors are now successfully getting through the enrollment process from beginning to end, but the website is still struggling to process enrollees and deliver accurate and verifiable information to health insurers. “Given all of the web site problems, I think 50,000 sounds pretty good, if this is actual private plan enrollments through the federal marketplace,” Tim Jost, a professor at William & Mary, told ThinkProgress. “I am surprised it is that high. But I hope it picks up for November and takes off for December. “
3. The Massachusetts experience predicted low early enrollment. In the first four months of enrollment in Commonwealth Care — the Massachusetts health care exchange for subsidized care — 15,560 of an estimated 80,000 uninsured who qualified for coverage signed up and after the first full year, one-third of the total eligible population — 122,000 people — became insured. The road to nearly universal coverage was gradual, as enrollment didn’t fully ramp up until almost a year after the initial rollout. Significantly, early enrollment data also showed a high number of Medicaid enrollees.
Here is a chart of enrollment for Commonwealth Care in 2007, the low-income program:
4. New public programs slowly ramp up to coverage. “Enrollment in new programs begins slowly and often takes several months to build momentum,” said Avalere CEO Dan Mendelson. Indeed, The Children’s Health Insurance Program (CHIP) and President George W. Bush’s Medicare Part D experienced this very same enrollment pattern. As Stan Dorn, a Senior Fellow at the Urban Institute’s Health Policy Center, told ThinkProgress, “It’s like any other human activity, it takes time to figure out how to do it right. CHIP, a bipartisan Clinton-era initiative that primarily provides health insurance to children in families with incomes too high to qualify for Medicaid, initially fell far short of enrollment goals and more than half of the seniors who signed up for Medicare Part D didn’t do so until after the initial enrollment period and enrolled despite the Bush administration’s well-publicized initial glitches in extending coverage to low-income beneficiaries.
5. The government didn’t market Obamacare. Given the technical glitches plaguing the site, the administration and outside groups couldn’t deploy a big public campaign urging uninsured people to sign-up for coverage and did not run a heavy media campaign in the 36 states where the federal government is operating the exchanges. As a result, news about reform was saturated by the website’s problems and likely depressed enrollment.
6. People less likely to sign up now for coverage that begins in January. “One would assume that people who are older and in poorer health would be the most persistent, at least initially, in navigating the federal website despite all the glitches and inability to complete the process,” Edwin Park, Vice President for Health Policy at the Center for Budget and Policy Priorities, said. This may be part of the reason why the insurance risk pools are coming in older than originally predicted. Administration officials say they expect younger people to enroll in coverage closer to the deadline (and when the first bill is due).