Obamacare Enrollment: Climbing, but Still Falling Far Short

By end of November, 137,000 had signed up through the federal exchange website.

Mercy Cabrera, an insurance agent with Sunshine Life and Health Advisors, speaks on the phone as she helps a person with information about an insurance policy under the Affordable Care Act at the store setup in the Westland Mall on November 14, 2013 in Hialeah, Florida.
National Journal
Sam Baker
Dec. 11, 2013, 4 a.m.

Obama­care en­roll­ment picked up slightly in Novem­ber but re­mains far short of the ad­min­is­tra­tion’s ini­tial tar­gets.

Roughly 264,000 people signed up for private in­sur­ance cov­er­age last month through state and fed­er­al ex­changes by the end of the month, ac­cord­ing to data from the Health and Hu­man Ser­vices De­part­ment. That brings the total to about 364,000 for Oc­to­ber and Novem­ber.

About 137,000 people have signed up so far through Health­Care.gov, the fed­er­ally run web­site that serves 36 states, HHS said. An­oth­er 227,000 have signed up in the 14 states that chose to set up their own ex­changes.

The dis­ap­point­ing re­port on Novem­ber en­roll­ment is not a sur­prise: Health­Care.gov was not work­ing for con­sumers for most of the month, and HHS wasn’t try­ing to dir­ect people to the site. En­roll­ment has surged since Dec. 1, when HHS an­nounced that the site is work­ing well for the “vast ma­jor­ity of users” — it re­cor­ded a com­bined 29,000 en­roll­ments on Dec. 1 and 2, fig­ures that aren’t re­flec­ted in the latest re­port.

Still, the site’s poor per­form­ance dur­ing Novem­ber has left en­roll­ment severely off track. The 364,000 people who have signed up through the first two months still fall short of the ad­min­is­tra­tion’s ex­pect­a­tions for Oc­to­ber alone. An­oth­er 3 mil­lion people would have to sign up this month alone in or­der to hit the ini­tial year-end goal.

HHS had ex­pec­ted 3.3 mil­lion people to sign up by the end of Decem­ber and 7 mil­lion by March 31, when the en­roll­ment win­dow closes. Al­though en­roll­ment will surely miss the mark for this year, HHS of­fi­cials said they re­main con­fid­ent they will reach their ul­ti­mate goal.

“No, we think we’re on track and we will reach the total that we thought. We’re only two and a half months in­to a six-month open-en­roll­ment peri­od,” said Mi­chael Hash, the dir­ect­or of HHS’s Of­fice of Health Re­form.

The ad­min­is­tra­tion could af­ford to fall some­what short of 7 mil­lion sign-ups. Al­though the mix of healthy versus sick en­rollees is per­haps more crit­ic­al to the law’s suc­cess than the total num­ber, each state’s ex­change still needs a crit­ic­al mass of people to re­main fin­an­cially vi­able.

The law in­cludes sev­er­al safety nets de­signed to pre­vent premi­ums from spik­ing if en­roll­ment falls short. Those mech­an­isms can help the ex­changes re­cov­er from a rough first year, but ex­perts don’t think they’re strong enough to off­set dis­astrously low en­roll­ment.

As many as 25 per­cent of en­roll­ment files pro­cessed in Oc­to­ber and Novem­ber con­tained er­rors that could af­fect con­sumers’ cov­er­age. Health­Care.gov sent in­com­plete, re­dund­ant, or faulty in­form­a­tion to in­sur­ance com­pan­ies, or failed to send en­roll­ment re­ports at all, for many of the people who were able to use the site. Some of those er­rors are minor, while oth­ers could res­ult in sig­ni­fic­ant prob­lems — such as people find­ing out they wer­en’t en­rolled in a plan they thought they had chosen.

In ad­di­tion to the 364,000 sign-ups for private in­sur­ance, an­oth­er 800,000 people have been de­term­ined eli­gible for Medi­caid or the Chil­dren’s Health In­sur­ance Pro­gram us­ing the law’s new in­sur­ance ex­changes, HHS said.

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