Obamacare Missed February Enrollment Target

February numbers fell short of expectations, but the law’s survival is still assured.

Health and Human Services Secretary Kathleen Sebelius sits with Senior Advisor to the President Valerie Jarrett before President Obama spoke on the Affordable Care Act in the Eisenhower Executive Office Building December 3, 2013.
National Journal
Sam Baker
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Sam Baker
March 11, 2014, noon

Roughly 4.2 mil­lion people had signed up for cov­er­age un­der Obama­care at the end of a weak­er-than-ex­pec­ted Feb­ru­ary, the Obama ad­min­is­tra­tion said Tues­day.

The ad­min­is­tra­tion’s en­roll­ment cam­paign is now in its in­tense fi­nal push ahead of the March 31 dead­line to sign up for cov­er­age. The White House and its al­lies are un­leash­ing a flood of paid ad­vert­ising, pro­mo­tion­al part­ner­ships, and grass­roots out­reach de­signed to coax con­sumers — and es­pe­cially young people — in­to new in­sur­ance mar­kets cre­ated by the health care law.

Feb­ru­ary’s pro­gress was slower than ex­pec­ted. About 943,000 people signed up for cov­er­age last month, com­pared with the nearly 1.3 mil­lion the Health and Hu­man Ser­vices De­part­ment had an­ti­cip­ated for Feb­ru­ary.

Young adults made up 24 per­cent of all new sign-ups — un­changed from last month. Ad­min­is­tra­tion of­fi­cials ini­tially set a tar­get of roughly 38 per­cent, but have since said that even hold­ing steady at about 25 per­cent is good enough.

Over­all en­roll­ment and the num­ber of young en­rollees are both ex­pec­ted to surge in March, thanks to the March 31 dead­line. But the ad­min­is­tra­tion would need an es­pe­cially strong month to hit an ul­ti­mate total of 6 mil­lion people — the latest tar­get from the Con­gres­sion­al Budget Of­fice.

When it plot­ted out its ex­pect­a­tions be­fore the Health­Care.gov launch, HHS es­tim­ated that about 80 per­cent of all en­rollees would be in the door by the end of Feb­ru­ary, and the re­main­ing 20 per­cent would come in March.

If that tra­ject­ory holds, based on last month’s fig­ures, total en­roll­ment will end up closer to 5.3 mil­lion.

Im­par­tial ex­perts agree that’s prob­ably enough, from a policy per­spect­ive. Really, the na­tion­al total doesn’t mean much — each state is its own mar­ket­place that has to live or die in­de­pend­ently. But get­ting close to 5 mil­lion en­rollees na­tion­ally is a good in­dic­at­or that each state has prob­ably reached a crit­ic­al mass.

The law has already cleared the threshold for ba­sic sur­viv­al, and from the White House’s per­spect­ive, that’s good enough for a year marred by the botched Health­Care.gov launch and a series of con­fus­ing delays. As long as premi­ums don’t skyrock­et next year, the Af­ford­able Care Act’s sys­tem of sub­sid­ized, reg­u­lated private cov­er­age is likely to be­come an in­grained part of the U.S. health care sys­tem.

Premi­ums will de­pend largely on who signs up for cov­er­age un­der the law — how many healthy con­sumers are in the mix to bal­ance out the costs of guar­an­tee­ing cov­er­age to people with preex­ist­ing con­di­tions. At the end of Feb­ru­ary, young adults made up 24 per­cent of en­rollees. That’s enough to avoid the dreaded in­sur­ance “death spir­al,” but could still lead to smal­ler premi­um in­creases next year, ac­cord­ing to the Kais­er Fam­ily Found­a­tion.

For all the con­cern about premi­ums, people still aren’t choos­ing the cheapest plans. Nearly two-thirds of all en­rollees, 63 per­cent, have se­lec­ted “sil­ver” plans, while just 18 per­cent have chosen cheap­er “bronze” policies and only 1 per­cent se­lec­ted bare-bones cata­stroph­ic cov­er­age. The law cat­egor­izes policies based on the rich­ness of their cov­er­age, and more gen­er­ous policies have high­er premi­ums.

Eighty-three per­cent of people who chose a plan are eli­gible for tax sub­sidies to help cov­er the cost of their premi­ums.

As al­ways, there are a few im­port­ant caveats to the latest en­roll­ment re­port. These are not fi­nal en­roll­ment num­bers. They re­flect the num­ber of people who have se­lec­ted an in­sur­ance plan — not the num­ber who have ac­tu­ally paid their first premi­um, and en­rolees aren’t covered un­til they make that pay­ment. In­surers have es­tim­ated that about 70 to 80 per­cent of their cus­tom­ers paid their first premi­um, which would put ac­tu­al en­roll­ment closer to 3 or 3.5 mil­lion.

The White House hasn’t re­leased a form­al tally of how many people paid their premi­ums, but should be able to do so once it has more com­plete data from in­surers.

These fig­ures also don’t break out the num­ber of un­in­sured people who have signed up for a plan, versus those who changed cov­er­age rather than gain­ing it (per­haps be­cause their old policy was can­celed as a res­ult of the Af­ford­able Care Act). The best es­tim­ates so far say that about 70 per­cent of all en­rollees were pre­vi­ously un­in­sured.

That may seem like nit­pick­ing, but it’s es­sen­tial in judging wheth­er the health care law lived up to ex­pect­a­tions. CBO has said it ex­pects the law to re­duce the num­ber of un­in­sured in the U.S. by about 13 mil­lion this year, in­clud­ing both its Medi­caid ex­pan­sion and in­sur­ance pur­chased through the ex­changes.

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