Obamacare’s Invisible Victory

Why the total enrollment number is actually bigger than you think.

National Journal
Sophie Novack
Add to Briefcase
Sophie Novack
March 28, 2014, 1 a.m.

Obama­care friends and foes alike are eagerly watch­ing the law’s in­sur­ance-en­roll­ment tally, ready to trum­pet every suc­cess or pounce on every fail­ure.

But as the fi­nal fig­ures be­fore the end of open en­roll­ment are pos­ted, a sig­ni­fic­ant chunk of people who bought in­sur­ance un­der the law will be miss­ing from the of­fi­cial tally.

That’s be­cause people who bought in­sur­ance dir­ectly from in­surers, and not through the law’s ex­changes, will not be in­cluded. And just how many people that rep­res­ents is a fig­ure that will not be avail­able in time for the big en­roll­ment-total re­veal — and likely not for a long time after.

Off-ex­change en­roll­ment is the for­got­ten piece of the Af­ford­able Care Act, but it could rep­res­ent mil­lions of people who are also get­ting covered as a res­ult of the health care law — many of whom are the young, healthy cus­tom­ers the ad­min­is­tra­tion is so ag­gress­ively pur­su­ing.

Un­for­tu­nately for the White House, no one really knows what those num­bers are, and few are talk­ing about them at all.

People who en­roll out­side of the ex­changes are simply us­ing a dif­fer­ent means to buy what are of­ten the same ACA-com­pli­ant plans avail­able in­side the ex­changes. They are part of the same risk pools and have the same im­pact on premi­ums.

When Health­Care.gov was not func­tion­ing in first month or two of open en­roll­ment, of­fi­cials en­cour­aged con­sumers to en­roll in cov­er­age off the ex­changes — an op­tion that by­passed the glitchy en­roll­ment sites and al­lowed con­sumers to work dir­ectly with in­sur­ance com­pan­ies. The ad­min­is­tra­tion then made the op­tion even easi­er by mak­ing the law’s premi­um sub­sidies avail­able to people who signed up dir­ectly with an in­surer.

The num­ber of people who have ac­tu­ally taken that ap­proach re­mains a mys­tery, but an­ec­dot­al re­ports sug­gest it could be sig­ni­fic­ant.

In Wash­ing­ton state — one of the only states to re­lease this in­form­a­tion — more people have signed up out­side the ex­change than in­side of it. The state in­sur­ance com­mis­sion­er’s of­fice says 183,618 people had en­rolled in private plans out­side of the ex­change as of the end of Feb­ru­ary, com­pared with 125,000 paid en­roll­ments the state ex­change is re­port­ing as of March 23.

In­surers’ data paint a sim­il­ar pic­ture. Well­Point has re­por­ted that as of the end of Janu­ary, 20 per­cent of its 500,000 new cus­tom­ers did not en­roll through the ACA’s ex­changes.

High­mark said that as of mid-Feb­ru­ary, about one-third of the over 110,000 people who bought ACA-com­pli­ant plans en­rolled dir­ectly with the com­pany. The in­surer of­fers plans in Delaware, Pennsylvania, and West Vir­gin­ia.

Neither Well­Point nor High­mark re­spon­ded to re­quests for up­dated num­bers.

The Blue Cross Blue Shield As­so­ci­ation, Amer­ica’s Health In­sur­ance Plans, and the Na­tion­al As­so­ci­ation of In­sur­ance Com­mis­sion­ers all said they do not have dir­ect-en­roll­ment data avail­able. Sev­er­al state ex­changes and state in­sur­ance com­mis­sion­ers said they do not col­lect that in­form­a­tion.

In­form­a­tion re­leased by eHealth — an on­line broker that pred­ates the health care law — in­dic­ates that the coveted young-adult demo­graph­ic is sign­ing up out­side of the ex­changes. About 45 per­cent of people ap­ply­ing for ACA-com­pli­ant plans through eHealth are between 18 and 34, the com­pany said — com­pared with roughly 25 per­cent in the ex­changes.

Bri­an Mast, vice pres­id­ent of com­mu­nic­a­tions for eHealth, says the com­pany has his­tor­ic­ally had a high por­tion of young en­rollees — around 50 per­cent — since young people are par­tic­u­larly in­clined to fa­vor com­plet­ing tasks quickly and on­line.

Roughly 170,000 people ap­plied for in­sur­ance plans through eHealth dur­ing the first three months of ACA open en­roll­ment — a 50 per­cent in­crease from the same quarter the year be­fore. Mast at­trib­utes the in­crease to the health care law.

“The pur­pose of our re­leases [Tues­day] and in late Feb­ru­ary was to draw at­ten­tion to the fact that there is a ro­bust mar­ket out­side the ex­changes,” Mast says. “It would be great if there were an ag­greg­ate num­ber for on and off [ex­changes], be­cause it would give a clear­er pic­ture of how en­roll­ment is go­ing.”

There is still a fair amount we don’t know about Obama­care en­roll­ment — the fi­nal tally from the Health and Hu­man Ser­vices De­part­ment will likely be skewed by the num­ber of in­di­vidu­als that the White House is count­ing as en­rolled, but who have not yet paid their premi­ums; and the health status of the risk pool is still largely a ques­tion mark.

But in the con­ver­sa­tion of what re­mains a mys­tery, off-ex­change en­roll­ment is largely left out. It’s quite pos­sible this num­ber would more than bal­ance out the premi­um pay­ment dis­crep­ancy — but un­for­tu­nately for HHS, we might not know for a very long time.

What We're Following See More »
HEALTH IN QUESTION
Sen. Cochran Back to Washington Tuesday
2 hours ago
THE LATEST
THIRD VERSION OF THE BAN
Federal Judge Temporarily Stops Trump’s Travel Ban
2 hours ago
THE LATEST

"A federal district court in Hawaii has temporarily blocked the third iteration of President Trump's travel ban. Judge Derrick Watson said the new targeted restrictions on travel from eight countries Trump issued on Sept. 24 suffers the same problems as the previous order."

Source:
FORMER ELI LILLY EXEC
Trump Leaning Towards Alex Azar for HHS
2 hours ago
THE DETAILS

"President Donald Trump is leaning toward nominating Alex Azar, a former pharmaceutical industry executive and George W. Bush administration official, to serve as Health and Human Services secretary, according to two White House officials...Azar is a veteran of HHS. He served as the department’s general counsel and deputy secretary during the Bush administration." He led Eli Lilly's U.S. operations from 2012-17.

Source:
ENOUGH SUPPORT TO PASS?
Senators Reach Bipartisan ACA Deal
3 hours ago
THE LATEST

"Sen. Lamar Alexander says he and Sen. Patty Murray have reached a deal to fund the Affordable Care Act's cost-sharing subsidies in exchange for giving states more regulatory flexibility with the law." Axios is watching to see if the deal will gather support.

Source:
INDEX UP MORE THAN 20% SINCE ELECTION
Dow Jones Hits 23,000 Threshold
6 hours ago
THE DETAILS
×
×

Welcome to National Journal!

You are currently accessing National Journal from IP access. Please login to access this feature. If you have any questions, please contact your Dedicated Advisor.

Login