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The Missing Millions in the Obamacare Enrollment Total The Missing Millions in the Obamacare Enrollment Total

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The Missing Millions in the Obamacare Enrollment Total

New numbers fill in some of the mystery of off-exchange enrollment—and significantly increase the total so far.



Blue Cross Blue Shield is adding nearly 2 million to the tally of customers buying insurance outside the Obamacare exchanges, a group that has been largely overlooked in the debate over enrollment numbers.

The association said Thursday that 1.7 million off-exchange customers enrolled in Blue Cross Blue Shield insurance plans compliant with the health care law between Oct. 1 and March 1. The total does not include the final month of the open-enrollment period, which ended Monday.


The figure is the largest yet in the limited data available on the Affordable Care Act's reach beyond the federal and state-based marketplaces.

The Obama administration announced this week that 7.1 million individuals have enrolled in private coverage through the ACA exchanges, surpassing the Congressional Budget Office's original target. The total has been hotly debated, with critics and supporters alike pointing out that we still don't know how many consumers have paid their first-month premiums (estimates have hovered between 80 and 90 percent), or what the breakdown of age and health status is of those enrolled. These are all important in evaluating the number actually getting coverage and the security of the risk pools.

Yet one of the biggest question marks has been largely excluded from the conversation, and it could add millions to the overall enrollment tally.


Off-exchange enrollment—directly with insurance companies or through private brokers and online sites—allows consumers to bypass the sometimes-troubled exchange websites to purchase coverage. They are not using the new enrollment vehicle, but they are often buying the same plans, and are part of the same risk pools, with the same impact on premium costs.

The Blue Cross Blue Shield total significantly increases the off-exchange total thus far.

Washington state—one of the only to release this data—had seen more than 180,000 people enroll in plans off the exchanges by the end of February, more than the 125,000 paid enrollments on the exchange as of March 23.

WellPoint has reported that as of the end of January, about 100,000 of its new customers did not enroll through the ACA's exchanges. Highmark said that as of mid-February, more than 35,000 people who bought ACA-compliant plans enrolled directly with the insurance company.


Reports indicate off-exchange enrollment could also have a healthier enrollment pool.

Online broker eHealth has had about 170,000 people apply for plans from October to December, and has found that its mix of enrollees skews significantly younger than the overall exchange total: About 45 percent applying through the company are in the 18-to-34 age bracket, compared with around 25 percent on the ACA marketplaces.

Blue Cross Blue Shield says they do not have information on the age or health status of the off-exchange enrollees, or on how many were new customers.

This article appears in the April 4, 2014 edition of NJ Daily.

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