Obamacare Sign-Ups Reach 8 Million

Deadlines work.

US President Barack Obama smiles during a state dinner in Berlin, on June 19, 2013. Obama said Russian and US nuclear weapons should be slashed by up to a third in a keynote speech in front of Berlin's iconic Brandenburg Gate in which he called for a world of 'peace and justice'. (MICHAEL SOHN/AFP/Getty Images)
National Journal
Sam Baker
April 17, 2014, 11:44 a.m.

Obama­care sign-ups reached 8 mil­lion as the first en­roll­ment win­dow came to a close, Pres­id­ent Obama said Thursday.

There are some big un­knowns be­hind that num­ber, but it is nev­er­the­less a hugely pos­it­ive fig­ure for the White House and Demo­crats. The March 31 dead­line to ap­ply for cov­er­age — and an ex­ten­sion for people who tried to meet the dead­line but couldn’t get through — pro­pelled an en­roll­ment surge that ex­ceeded just about every­one’s ex­pect­a­tions.

Some 3.7 mil­lion people signed up in March and April alone — more than in the first four months of en­roll­ment com­bined, and more than double what the Health and Hu­man Ser­vices De­part­ment had ini­tially an­ti­cip­ated, even though it ex­pec­ted a spike at the end of the open-en­roll­ment win­dow.

The law’s ex­changes are now on track to meet cov­er­age tar­gets that seemed wildly out of reach dur­ing the dis­astrous Health­Care.gov launch and were still some­what un­real­ist­ic as re­cently as last month.

Obama took the op­por­tun­ity to knock Re­pub­lic­ans for their un­waver­ing op­pos­i­tion to the law and con­tin­ued votes to re­peal or weak­en it.

“They still can’t bring them­selves to ad­mit that the Af­ford­able Care Act is work­ing,” Obama said. “They said nobody would sign up. They were wrong about that. They said it would be un­af­ford­able for the coun­try. They were wrong about that.”

The Health and Hu­man Ser­vices De­part­ment said young adults make up 28 per­cent of en­rollees — less than the White House had ini­tially hoped for, but roughly in line with the ex­per­i­ence in Mas­sachu­setts and with at least some in­surers’ ex­pect­a­tions.

The usu­al caveats ap­ply: We don’t know how many of these 8 mil­lion people went on to pay their first month’s premi­um, which is the last step to ac­tu­ally get­ting covered. And we don’t know how many were pre­vi­ously un­in­sured.

Both of those an­swers are im­port­ant to get­ting an ac­cur­ate pic­ture of en­roll­ment, but neither is likely to re­verse the broad­er suc­cess story en­roll­ment has be­come.

Some in­surers have said that, as of Feb­ru­ary, 15 per­cent to 20 per­cent of their Obama­care cus­tom­ers didn’t make their first premi­um pay­ment. If that trend holds across all plans through the end of en­roll­ment, Thursday’s 8 mil­lion sign-ups would trans­late in­to ac­tu­al en­roll­ment some­where between 6.4 mil­lion and 6.8 mil­lion — still more than the Con­gres­sion­al Budget Of­fice an­ti­cip­ated.

CBO still says it ex­pects the ex­changes to cov­er 6 mil­lion people this year, after ac­count­ing for people who will not com­plete their en­roll­ment or who will leave the mar­ket­place at some point dur­ing the year — for ex­ample, be­cause they got a new job that of­fers health be­ne­fits. People can also still come in­to the ex­changes if they lose their jobs or ex­per­i­ence oth­er spe­cial cir­cum­stances.

It’s also not clear how many people who signed up through the ex­changes were pre­vi­ously un­in­sured. A re­cent sur­vey by Rand said as few as one-third of new en­rollees were pre­vi­ously un­in­sured — less than the White House would need to meet CBO’s ex­pect­a­tions for re­du­cing the num­ber of un­in­sured Amer­ic­ans.

But ex­change cov­er­age isn’t the whole pic­ture.

The 8 mil­lion total doesn’t in­clude people who gained cov­er­age be­cause of Obama­care’s Medi­ciad ex­pan­sion — about 3 mil­lion so far, ac­cord­ing to the Obama ad­min­is­tra­tion. Twenty-six states are par­ti­cip­at­ing in the Medi­caid ex­pan­sion, and Obama sharply cri­ti­cized the hol­d­outs dur­ing his news con­fer­ence Thursday, ac­cus­ing them of act­ing ” for no reas­on oth­er than polit­ic­al spite.”

It also doesn’t in­clude people who signed up dir­ectly with in­sur­ance com­pan­ies, by­passing the ex­changes. Dir­ect en­roll­ment was a pop­u­lar op­tion in the wake of Obama­care’s plan can­cel­la­tions: People who wouldn’t qual­i­fy for fin­an­cial help through the ex­changes simply signed up with a new plan dir­ectly from their in­surer, es­pe­cially while Health­Care.gov wasn’t work­ing.

CBO es­tim­ated that about 5 mil­lion people have pur­chased cov­er­age dir­ectly from in­surers.

Those con­sumers don’t count to­ward the ex­changes’ total, but they’re part of the same risk pool as people who sign up through the new mar­ket­places. In­surers don’t make a dis­tinc­tion when set­ting premi­ums.

A full en­roll­ment re­port with more-de­tailed demo­graph­ic in­form­a­tion won’t be avail­able un­til next week.

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