Obamacare Enrollment Is Back on Track

US President Barack Obama waves and smiles after a reporter asked a question during his departure from the White House in Washington, DC, September 20, 2013.
National Journal
Sam Baker
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Sam Baker
Feb. 12, 2014, 10:18 a.m.

With two months left to go, Obama­care en­roll­ment is on track to hand the White House a sig­ni­fic­ant win over the law’s crit­ics.

About 3.3 mil­lion people had signed up for private in­sur­ance plans through the end of Janu­ary, ac­cord­ing to new data the Health and Hu­man Ser­vices De­part­ment re­leased Wed­nes­day. Janu­ary it­self was a little bet­ter than ex­pec­ted, and the growth put the ad­min­is­tra­tion with­in reach of a strong total when open en­roll­ment ends in March.

There are sig­ni­fic­ant gaps in the data that could af­fect as­sess­ment of the law’s ul­ti­mate suc­cess, but bar­ring any wild sur­prises, things are look­ing good for the White House.

Here’s what you need to know from the latest data:

En­roll­ment is on track

The en­roll­ment pro­cess has re­covered from the dis­astrous Health­Care.gov launch, and has made up a lot of the ground it lost to the web­site’s dys­func­tion.

Tak­ing Health­Care.gov‘s woes in­to ac­count, the Con­gres­sion­al Budget Of­fice now ex­pects about 6 mil­lion people to sign up by the end of the en­roll­ment win­dow. We’re two-thirds of the way in­to open en­roll­ment, and the law is 55 per­cent of the way to that tar­get.

Some of the law’s crit­ics will surely want to judge en­roll­ment against the tar­gets CBO set be­fore the Health­Care.gov launch, which puts it fur­ther be­hind — but still not by much. Real-life en­roll­ment is 25 per­cent short of HHS’ pre-Health­Care.gov es­tim­ates.

Janu­ary saw a slight drop-off, as ex­pec­ted

White House of­fi­cials and health policy ex­perts fully ex­pec­ted Janu­ary en­roll­ment to be lower than Decem­ber’s. They figured Decem­ber would rep­res­ent an en­roll­ment surge, as people tried to meet the dead­line to get cov­er­age that began on Jan. 1 — the earli­est pos­sible date — and ex­pec­ted en­roll­ment to taper off in Janu­ary and Feb­ru­ary.

The drop-off happened, but it was small. About 1.8 mil­lion people en­rolled in Decem­ber, com­pared with 1.1 mil­lion last month.

The num­ber of young people is steady

Any­one who wants Obama­care to work wants to see a lot of young people sign up. (Really, they want to see a lot of healthy people sign up, but we use age as a proxy for health status.)

The ra­tio of young adults was largely un­changed in Janu­ary, hold­ing at about 25 per­cent. That num­ber needs to go up, but it’s still too early to pan­ic. Young people were al­ways ex­pec­ted to sign up at the last minute.

Ini­tially, the White House said it wanted young adults to make up about 38 per­cent of all en­rollees. Sit­ting at 25 per­cent now is a sign that the bench­mark — or something close to it — is achiev­able by the end of March. The mix is good enough now to avoid a “death spir­al,” ac­cord­ing to the Kais­er Fam­ily Found­a­tion, but the high­er the per­cent­age of young en­rollees gets, the lower the like­li­hood of big premi­um in­creases next year.

We don’t know how many people are truly en­rolled

As usu­al, HHS’s re­port con­siders people “en­rolled” as long as they’ve gone through the pro­cess and se­lec­ted a plan. But you’re not truly en­rolled — you don’t have in­sur­ance that you can use — un­til after you’ve paid your first month’s premi­um.

It’s safe to as­sume that some num­ber of people haven’t made that pay­ment, but we don’t know how many. Un­til we do, we won’t know how many people truly are en­rolled in health in­sur­ance via Obama­care.

We don’t know how many un­in­sured people are get­ting covered

The goal of the Af­ford­able Care Act wasn’t simply to cov­er mil­lions of people, but to re­duce the num­ber of un­in­sured by mil­lions of people — 6 mil­lion in the first year, ramp­ing up to about 24 mil­lion, ac­cord­ing to CBO’s es­tim­ates. But ini­tial re­ports sug­gest that a lot of the people get­ting covered through the ex­changes were already in­sured; they’re chan­ging their cov­er­age rather than gain­ing it. For now, no one really knows how many pre­vi­ously un­in­sured people are in­cluded in the 3.3 mil­lion total, but that will be a key met­ric of Obama­care’s suc­cess.

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