Health Care

15-20 Percent Aren’t Paying Obamacare Premiums, Insurer Says

New data from a major insurer suggest real enrollment is at roughly 6 million.

PASADENA, CA - NOVEMBER 19: A healthcare reform specialist helps people select insurance plans at the free Affordable Care Act (ACA) Enrollment Fair at Pasadena City College on November 19, 2013 in Pasadena, California. The event, sponsored by the Chamber of Commerce and the Los Angeles Association of Health Underwriters, offers one-on-one sessions with insurance experts certified by Covered California to help people enroll for healthcare coverage under the ACA. 
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Sam Baker
April 2, 2014, 10:10 a.m.

One of the biggest play­ers in Obama­care’s ex­changes says 15 to 20 per­cent of its new cus­tom­ers aren’t pay­ing their first premi­um — which means they’re not ac­tu­ally covered.

The latest data come from the Blue Cross Blue Shield As­so­ci­ation, whose mem­bers — known col­lect­ively as “Blues” plans — are par­ti­cip­at­ing in the ex­changes in al­most every state. Roughly 80 to 85 per­cent of people who se­lec­ted a Blues plan through the ex­changes went on to pay their first month’s premi­um, a BCBSA spokes­wo­man said Wed­nes­day.

The new stat­ist­ics, par­tic­u­larly from such a large car­ri­er, help define how many people are ac­tu­ally get­ting covered un­der the Af­ford­able Care Act.

The Blues’ ex­per­i­ence is in line with an­ec­dot­al es­tim­ates from oth­er in­sur­ance ex­ec­ut­ives, who in­dic­ated earli­er in the en­roll­ment pro­cess that they re­ceived pay­ments from about 80 per­cent of people who se­lec­ted their plans.

The Blues’ latest es­tim­ate in­cludes policies that took ef­fect Feb. 1 or earli­er, the spokes­wo­man said.

Some health care ana­lysts have sug­ges­ted that the pay­ment rate could im­prove later in the en­roll­ment win­dow, as plans had more time to track down con­sumers who hadn’t paid.

Wherever the fi­nal num­ber ends up, it will be the real meas­ure of how many people are ac­tu­ally covered through the Af­ford­able Care Act’s ex­changes. The Obama ad­min­is­tra­tion has been re­leas­ing the num­ber of people who se­lec­ted a plan, but says it doesn’t have ac­cur­ate data on how many have ac­tu­ally paid. And con­sumers don’t have cov­er­age they can use un­til they make that first pay­ment.

If the na­tion­wide pay­ment rate, across all car­ri­ers, re­mains at 80 to 85 per­cent, the 7.1 mil­lion sign-ups Obama an­nounced Tues­day would trans­late in­to some­where between 5.7 and 6 mil­lion people who are ac­tu­ally covered.


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