Where Obamacare Is Strongest (and Where It’s Falling Short)

The final report on Obamacare sign-ups shows a huge swing in states’ success.

National Journal
Sam Baker and Sophie Novack
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Sam Baker Sophie Novack
May 1, 2014, 10:23 a.m.

The ques­tion of Obama­care’s ul­ti­mate suc­cess doesn’t have just one an­swer — it has 51.

Each state is its own in­sur­ance mar­ket­place, and has its own set of in­sur­ance com­pan­ies selling products with­in its new in­sur­ance ex­change. And there’s a huge gap in how well the states fared dur­ing Obama­care’s first open-en­roll­ment win­dow.

The Health and Hu­man Ser­vices De­part­ment re­leased its fi­nal sign-up fig­ures Thursday, and the biggest head­line from the re­port is one we already knew: About 8 mil­lion people — more pre­cisely, 8.02 mil­lion — picked a plan through the Af­ford­able Care Act’s ex­changes dur­ing the six-month en­roll­ment win­dow.

Roughly 28 per­cent of them were young adults — not as high as the ad­min­is­tra­tion wanted, but ap­par­ently not too far out of line with what in­sur­ance com­pan­ies pre­dicted.

Both na­tion­al totals are im­port­ant polit­ic­al met­rics, but to take stock of where the health care law stands as it ap­proaches the second year of en­roll­ment, the real story is in the states.

Here are the five states that signed up the highest per­cent­age of their eli­gible res­id­ents, based on the Kais­er Fam­ily Found­a­tion’s es­tim­ates of who’s eli­gible for ex­change cov­er­age:

1. Ver­mont (85 per­cent)

2. Cali­for­nia (43 per­cent)

3. Rhode Is­land (41 per­cent)

4. Flor­ida (39 per­cent)

5. Idaho (38 per­cent)

And the five that signed up the low­est per­cent­age:

1. South Dakota (11 per­cent)

2. Iowa (11 per­cent)

3. Mas­sachu­setts (12 per­cent)

4. North Dakota (14 per­cent)

5. Hawaii (15 per­cent)

How many are newly in­sured?

The latest HHS re­port also of­fers a little more in­form­a­tion — though still not a com­plete an­swer — about the num­ber of people who were pre­vi­ously un­in­sured when they picked a plan through Obama­care. It’s an im­port­ant ques­tion be­cause the goal of the law is to re­duce the num­ber of un­in­sured Amer­ic­ans — not just to change the cov­er­age people have.

HHS doesn’t have de­tailed in­form­a­tion about people’s pri­or cov­er­age, but con­sumers do have to list their in­sur­ance status when they ap­ply for fin­an­cial as­sist­ance through the ex­changes. Of the people who ap­plied for tax sub­sidies and went on to pick a plan through fed­er­ally run ex­changes — about 5 mil­lion people — only 13 per­cent said they already had some form of cov­er­age, ac­cord­ing to HHS’s latest re­port.

Out­side es­tim­ates, in­clud­ing a re­cent ana­lys­is from the Rand Cor­por­a­tion, have sug­ges­ted the share of pre­vi­ously in­sured con­sumers is sig­ni­fic­antly high­er — as high as 60 per­cent, ac­cord­ing to Rand.

What is the demo­graph­ic break­down?

Of those who op­ted to re­port race/eth­ni­city on their ap­plic­a­tions, whites rep­res­en­ted the largest por­tion of en­rollees, at 62.9 per­cent. Afric­an-Amer­ic­ans made up 16.7 per­cent, Lati­nos made up 10.7 per­cent, and Asi­ans were 7.9 per­cent. Al­most one-third of the 5.4 mil­lion people who signed up for cov­er­age on the fed­er­ally fa­cil­it­ates mar­ket­place de­clined to se­lect their race or eth­ni­city, or marked “oth­er.”

Thursday’s en­roll­ment re­port only in­cluded demo­graph­ic in­form­a­tion from the states par­ti­cip­at­ing in the fed­er­al mar­ket­place, and the three state-based ex­changes that have re­leased that in­form­a­tion: Cali­for­nia, Wash­ing­ton, and Nevada.

There has been a large fo­cus on en­rolling Lati­nos in health cov­er­age through the Af­ford­able Care Act, as the group makes up one-quarter of all eli­gible un­in­sured in­di­vidu­als in the U.S., and is un­in­sured at a far high­er rate than the over­all U.S. pop­u­la­tion.

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