Obamacare Exchanges Are Holding Up, But What About Enrollment Numbers?

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In the past five months, 4.2 million Americans have signed up for health insurance plans through the health insurance exchanges created by the Affordable Care Act, the Department of Health and Human services reported Tuesday. During February alone, 943,000 people enrolled in Obamacare marketplace plans, and just weeks remain before the six-month enrollment period comes to a close on March 31. “Now, during this final month of open enrollment our message to the American people is this: you still have time to get covered, but you’ll want to sign up today,” noted the HHS Secretary Kathleen Sebelius in a press release announcing the enrollment number. The announcement coincided with the broadcast of President Barack Obama’s appearance on “Between Two Ferns with Zach Galifianakis” on the Funny or Die website. It was an unabashed “plug” for young people to sign up for coverage. Galifianakis even said, “Here we go, okay, let’s get this out of the way, what did you come here to plug?”

To which Obama responded, “Well, first of all, I think it’s fair to say that I wouldn’t be with you here today if I didn’t had something to plug. Have you heard of the Affordable Care Act?” He then proceeded to explain that, “Millions of Americans have already gotten health insurance plans” through the exchanges and that most young Americans can “get coverage all for what it costs to pay your cell phone bill.”

It is a pitch that the president has made on numerous occasions. But while the administration has done much to restore confidence in the healthcare reform after the public relations nightmare brought on by the glitch-riddled rollout of the insurance exchange system, and while  enrollments did gain momentum in December and January, that momentum has been lost.

Fewer individuals enrolled in February than did in each of the previous two months, which each saw more than 1 million plans purchased. At the current pace, 2014 enrollments are not likely to meet the Obama administration’s downwardly revised goal for the year of 6 million. Originally, 7 million enrollments were expected, but the nonpartisan Congressional Budget Office lowered the original goal thanks to the software errors and design flaws that caused hours-long wait times, prevented potential customers from creating accounts and completing the 30-step enrollment process, and sent insurers the wrong information.

Using September projections from the CBO, which were made weeks before the rocky Healthcare.gov rollout, the Obama administration had expected 1.27 million people would enroll in February alone.

More concerning is the fact that the young people — to whom Obama’s appearance on “Between Two Ferns” was meant to appeal — are not enrolling at targeted rates. The report from HHS showed that of the 4.2 million Americans who have enrolled in insurance polices through the state-based insurance exchanges, 25 percent were between the ages of 18 and 34 years old, a level unchanged from the previous reporting period. Yet, the Obama administration originally calculated that of the 7 million people who are expected to enroll via the Affordable Care Act’s exchanges around 2.7 million need to be young adults. It is their premiums that will cover the higher bills for the relatively small number of chronically ill people who sign up for coverage.

Healthcare experts say 40 percent of new enrollees must be young, healthy, and cheap-to-insure for risk pools to be broad enough. Government officials are expecting that the so-called “invincibles,” or young healthy adults who can help spread out the risk for the program, are procrastinating about signing up, meaning there will be a rush of enrollments in the final weeks before March 31. Based on its experience with the Medicare prescription drug program, an “enrollment surge is expected in March as the close of the initial open enrollment period approaches for the Marketplace,” HHS noted.

The report also reported that 55 percent of enrollees are female and 45 percent are male; 63 percent selected a Silver plan — the second most expensive –and 18 percent selected a Bronze plan; and 83 percent are eligible to receive the tax credit to subsidize premium costs. It is important to remember that Tuesday’s numbers only represent plan selections. What is unclear is how many people have paid the first month’s premium, the final step in completing enrollment, and how many exchange signups represented previously uninsured individuals. A survey conducted by McKinsey and Co. suggests that 27 percent of enrollees were previously uninsured.

Separately reported data from research firm Gallup showed that the uninsured rate declined in February. “The uninsured rate continues to decline after the requirement to have health insurance went into effect on January 1, 2014,” noted an early March survey of Americans used to compile the Gallup-Healthways Well-Being Index. In fact, the survey found that the uninsured rate in the United States in on track to be the lowest quarterly level that Gallup and Healthways have measured since 2008. Now 15.9 percent of Americans do not have health insurance, which compares with the 17.1 percent of Americans who did not have coverage in the final months of 2013. “This drop could be a result of the [the Affordable Care Act] which aims to provide healthcare coverage to more Americans through multiple provisions, including federal and state healthcare marketplaces where Americans can purchase health insurance coverage at competitive rates.”

“That didn’t just happen on its own,” Sebelius said in response to questions from reporters Tuesday.

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