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
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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.

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