Where Obamacare Is Still Struggling

Some states haven’t recovered from low enrollment in the law’s first year.

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
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Sam Baker
Jan. 14, 2015, 1:53 p.m.

Obama­care en­roll­ment is do­ing fine na­tion­ally, but it’s still lag­ging in a hand­ful of key 2016 battle­grounds.

Nevada is hav­ing an es­pe­cially rough time. Iowa is mak­ing slow pro­gress. And Ohio still has some work to do as well. They’re among the hand­ful of states that got off to es­pe­cially rocky starts when Obama­care en­roll­ment began, and—at least for now—haven’t been able to fully turn things around in the law’s second year, ac­cord­ing to new fig­ures from the Obama ad­min­is­tra­tion.

There’s still time: Open en­roll­ment doesn’t end for an­oth­er month, and most ex­perts are ex­pect­ing a surge in sign-ups ahead of the Feb. 15 dead­line to buy cov­er­age. And no state is do­ing as poorly as the law’s crit­ics have pre­dicted: No one’s in­sur­ance mar­ket is in danger of col­lapsing.

But the first state-by-state break­down of 2015 en­roll­ment—which the Health and Hu­man Ser­vices De­part­ment re­leased Wed­nes­day—shows big vari­ations in en­roll­ment growth, par­tic­u­larly among states that didn’t do well dur­ing the first open-en­roll­ment peri­od.

States like Texas and Flor­ida, which en­rolled es­pe­cially large por­tions of their un­in­sured pop­u­la­tions last year, don’t need to see a big spike in the num­ber of people sign­ing up for cov­er­age this year—they’re already on the right track.

But oth­er states fell far short of their en­roll­ment goals last year, sign­ing up only a frac­tion of their un­in­sured res­id­ents. Those states need to see sig­ni­fic­ant growth this time around. Each state is its own in­sur­ance mar­ket; premi­um in­creases vary from state to state, as will Obama­care’s suc­cess or fail­ure.

Wyom­ing, for ex­ample, is mak­ing up for lost time. It ranked near the bot­tom last year in terms of sign­ing up eli­gible res­id­ents. But sign-ups in the state have already in­creased by 42 per­cent since then—the biggest growth rate in the coun­try.

North Dakota, Ok­lahoma, and Neb­raska are also see­ing at least a 30 per­cent in­crease in sign-ups after poor show­ings in 2014.

“Some of the highest growth is in mar­kets that did less well last year,” said Larry Levitt, seni­or ad­viser for spe­cial ini­ti­at­ives at the Kais­er Fam­ily Found­a­tion.

But some of the low­est growth is also com­ing from states that did poorly last year:

Nevada ranked 43rd last year in the num­ber of eli­gible res­id­ents who ac­tu­ally signed up for cov­er­age. Since then, sign-ups have grown at an an­em­ic 5.3 per­cent—the low­est rate of growth in any state.

Nevada’s ex­change has been be­set by tech­nic­al prob­lems, and its total num­ber of sign-ups as of last week was only about 2,000 high­er than its totals in April. That growth rate is so small, it might not even make up for the people who signed up but nev­er paid their premi­ums, Levitt said.

Sim­il­arly, Iowa was second-to-last in 2014, sign­ing up only about 13 per­cent of eli­gible res­id­ents. Sign-ups are 18 per­cent high­er this year, com­pared with 24 per­cent na­tion­ally.

The latest data cov­er only the 37 states that are re­ly­ing on Health­Care.gov to op­er­ate their ex­changes. Four of those states were in the bot­tom 10 per­formers last year and are also in the bot­tom 10 states for growth this year.

It’s not en­tirely clear why en­roll­ment is grow­ing faster in cer­tain states, Levitt said. But he said the dis­crep­an­cies raise an im­port­ant point about Obama­care’s fu­ture: While big, pop­u­lous states like Cali­for­nia and Flor­ida pro­pelled the law to an en­roll­ment suc­cess in its first year, and will add mil­lions more people to the rolls in 2015, the law will need high­er en­roll­ment from “un­like­li­er places” to truly keep grow­ing in the long term.

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