The Missing Millions in the Obamacare Enrollment Total

New numbers fill in some of the mystery of off-exchange enrollment — and significantly increase the total so far.

National Journal
Sophie Novack
April 3, 2014, 2:54 p.m.

Blue Cross Blue Shield is adding nearly 2 mil­lion to the tally of cus­tom­ers buy­ing in­sur­ance out­side the Obama­care ex­changes, a group that has been largely over­looked in the de­bate over en­roll­ment num­bers.

The as­so­ci­ation said Thursday that 1.7 mil­lion off-ex­change cus­tom­ers en­rolled in Blue Cross Blue Shield in­sur­ance plans com­pli­ant with the health care law between Oct. 1 and March 1. The total does not in­clude the fi­nal month of the open-en­roll­ment peri­od, which ended Monday.

The fig­ure is the largest yet in the lim­ited data avail­able on the Af­ford­able Care Act’s reach bey­ond the fed­er­al and state-based mar­ket­places.

The Obama ad­min­is­tra­tion an­nounced this week that 7.1 mil­lion in­di­vidu­als have en­rolled in private cov­er­age through the ACA ex­changes, sur­pass­ing the Con­gres­sion­al Budget Of­fice’s ori­gin­al tar­get. The total has been hotly de­bated, with crit­ics and sup­port­ers alike point­ing out that we still don’t know how many con­sumers have paid their first-month premi­ums (es­tim­ates have hovered between 80 and 90 per­cent), or what the break­down of age and health status is of those en­rolled. These are all im­port­ant in eval­u­at­ing the num­ber ac­tu­ally get­ting cov­er­age and the se­cur­ity of the risk pools.

Yet one of the biggest ques­tion marks has been largely ex­cluded from the con­ver­sa­tion, and it could add mil­lions to the over­all en­roll­ment tally.

Off-ex­change en­roll­ment — dir­ectly with in­sur­ance com­pan­ies or through private brokers and on­line sites — al­lows con­sumers to by­pass the some­times-troubled ex­change web­sites to pur­chase cov­er­age. They are not us­ing the new en­roll­ment vehicle, but they are of­ten buy­ing the same plans, and are part of the same risk pools, with the same im­pact on premi­um costs.

The Blue Cross Blue Shield total sig­ni­fic­antly in­creases the off-ex­change total thus far.

Wash­ing­ton state — one of the only to re­lease this data — had seen more than 180,000 people en­roll in plans off the ex­changes by the end of Feb­ru­ary, more than the 125,000 paid en­roll­ments on the ex­change as of March 23.

Well­Point has re­por­ted that as of the end of Janu­ary, about 100,000 of its new cus­tom­ers did not en­roll through the ACA’s ex­changes. High­mark said that as of mid-Feb­ru­ary, more than 35,000 people who bought ACA-com­pli­ant plans en­rolled dir­ectly with the in­sur­ance com­pany.

Re­ports in­dic­ate off-ex­change en­roll­ment could also have a health­i­er en­roll­ment pool.

On­line broker eHealth has had about 170,000 people ap­ply for plans from Oc­to­ber to Decem­ber, and has found that its mix of en­rollees skews sig­ni­fic­antly young­er than the over­all ex­change total: About 45 per­cent ap­ply­ing through the com­pany are in the 18-to-34 age brack­et, com­pared with around 25 per­cent on the ACA mar­ket­places.

Blue Cross Blue Shield says they do not have in­form­a­tion on the age or health status of the off-ex­change en­rollees, or on how many were new cus­tom­ers.

What We're Following See More »
FOLLOWED CLOSED DOOR MEETING
Peña Nieto, Trump Trade Subtle Jabs in Statements
6 hours ago
THE DETAILS

Following their meeting, President Enrique Peña Nieto of Mexico and Republican nominee for president, Donald Trump, briefly addressed the media, with Peña Nieto subtly rebuking Trump's rhetoric. While he spoke respectfully about Trump, Peña Nieto did not back down, saying that free trade has proved effective and that illegal immigration into America from the south has decreased over the last ten years while the flow of people and drugs into Mexico has increased. Additionally, he stressed that Mexicans in America are "honest" and "deserve respect." Trump responded, calling some Mexicans "tremendous people" while saying others are "beyond reproach." Trump laid out five important issues, including the end of illegal immigration and the ability for either country to build a wall or border. However, Trump said he did not discuss who would pay for the wall.

LOWER COURT RULING STANDS
SCOTUS Won’t Restore NC Voter ID Law
6 hours ago
THE LATEST

A divided Supreme Court "refused Wednesday to reinstate North Carolina’s voter identification requirement and keep just 10 days of early in-person voting. The court rejected a request by Gov. Pat McCrory and other state officials to delay a lower court ruling that found the state law was tainted by racial discrimination."

Source:
SMOKIN’ AND SHOOTIN’
Court: 2nd Amendment Doesn’t Protect Pot Users’ Gun Rights
7 hours ago
THE DETAILS
CHICAGO DISTRICT
Woman Self-Immolates in Congressman’s Office
9 hours ago
THE DETAILS

"Police say a woman walked into U.S. Rep. Danny Davis' office on Chicago's West Side, drank out of a bottle of hand sanitizer, poured the sanitizer over herself and set herself on fire with a lighter." The Democrat wasn't in the office at the time.

Source:
ASKS CONGRESS FOR $1.1 BILLION MORE
White House Grants $53 Million for Opioids
11 hours ago
THE LATEST

"The Department of Health and Human Services on Wednesday awarded 44 states, four tribes and the District of Columbia a combined $53 million in grants to expand access to treatment for opioid use disorders and ultimately aimed at reducing the number of opioid-related deaths." But HHS Secretary Sylvia Burwell and drug czar Michael Botticelli both called on Congress to approve the $1.1 billion Obama has requested to fight the opioid crisis.

Source:
×