HHS Doesn’t Know How Many Uninsured Are Signing Up for Obamacare

“That’s not a data point we are really collecting in any sort of systematic way,” says a senior official.

Secretary of Health and Human Services Kathleen Sebelius speaks during an event in the East Room of the White House February 27, 2014 in Washington, DC.
National Journal
Sam Baker
March 6, 2014, 11:03 a.m.

There’s a lot we don’t know about how Obama­care en­roll­ment is go­ing. Ap­par­ently that’s also true even with­in the Obama ad­min­is­tra­tion.

Gary Co­hen, the soon-to-be-former dir­ect­or of the main im­ple­ment­a­tion of­fice at the Health and Hu­man Ser­vices De­part­ment, stopped by an in­sur­ance in­dustry con­fer­ence Thursday to of­fer an up­date on en­roll­ment. The main points were fa­mil­i­ar: People are sign­ing up (about 4 mil­lion have picked a plan so far), and the ad­min­is­tra­tion is go­ing all out to pro­mote Obama­care over the last few weeks of the en­roll­ment win­dow.

But Co­hen didn’t have much more to of­fer in­surers — who need this to work just as much as the White House — on some of the biggest un­knowns about the law’s pro­gress:

How many un­in­sured people are sign­ing up?

The Con­gres­sion­al Budget Of­fice es­tim­ates that the health care law will re­duce the num­ber of un­in­sured people by about 24 mil­lion over the next few years, and that about 6 mil­lion pre­vi­ously un­in­sured people will gain cov­er­age through the law’s ex­changes this year. So, is en­roll­ment on track to meet that goal? Over­all en­roll­ment is look­ing pretty de­cent, but how many of the people who have signed up were pre­vi­ously un­in­sured?

“That’s not a data point that we are really col­lect­ing in any sort of sys­tem­at­ic way,” Co­hen told the in­sur­ance-in­dustry crowd on Thursday when asked how many of the roughly 4 mil­lion en­rollees were pre­vi­ously un­in­sured.

New York state is col­lect­ing that data, and it says about 70 per­cent of its en­rollees were not covered be­fore, while about 30 per­cent are chan­ging their cov­er­age rather than gain­ing it.

How many people signed up dir­ectly with in­surers?

When Health­Care.gov was broken in Oc­to­ber and Novem­ber, HHS and in­surers agreed on “dir­ect en­roll­ment” as a work­around — en­cour­aging people to sign up dir­ectly with in­sur­ance com­pan­ies. It’s also an op­tion for people who are too wealthy to get a sub­sidy to help cov­er their premi­ums (the main be­ne­fit of us­ing the ex­changes), or who had a plan can­celed and want to stick with the same car­ri­er. Co­hen was asked Thursday how many people have signed up out­side the ex­changes.

“I don’t think we have done any­thing to try to col­lect that sort of data,” he said.

How many people has the Medi­caid ex­pan­sion covered?

In states that went along with the law’s Medi­caid ex­pan­sion, people are now eli­gible for the pro­gram with an in­come up to 133 per­cent of the fed­er­al poverty line. The ad­min­is­tra­tion provides over­all Medi­caid en­roll­ment num­bers, but those re­ports don’t break out who is newly eli­gible, who was pre­vi­ously eli­gible but not en­rolled, and who was simply re­new­ing their Medi­caid cov­er­age through the ex­changes.

This one, to be fair, is a little tricky.

It wouldn’t be fair to the ad­min­is­tra­tion to as­sume that Obama­care only gets cred­it for newly eli­gible en­rollees. There’s a huge push un­der­way right now to get people en­rolled, and ex­perts al­ways re­cog­nized that, with such a big health care push go­ing on in low-in­come com­munit­ies, a lot of pre­vi­ously eli­gible people would get curi­ous and sign up. It’s called “wood­work­ing” — people who already could have been en­rolled but, for whatever reas­on, hadn’t, un­til the Obama­care en­roll­ment drive brought them out of the wood­work.

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