What the Low Obamacare Enrollment Numbers Mean

The bumpy performance of the new insurance exchange shows what’s working and what’s not.

Mario Ricart and Rudy Figueroa insurance agents with Sunshine Life and Health Advisors help people with information about policies that are available to them under the Affordable Care Act at a kiosk setup at the Mall of Americas on November 5, 2013 in Miami, Florida.
National Journal
Sam Baker
Nov. 13, 2013, 5 p.m.

Roughly 100,000 people en­rolled in health in­sur­ance through Obama­care last month — far short of the ad­min­is­tra­tion’s goal. The much-an­ti­cip­ated stat­ist­ic was not sur­pris­ing, but it does help shape a clear­er as­sess­ment of Pres­id­ent Obama’s sig­na­ture pro­gram.

The en­roll­ment num­bers the Health and Hu­man Ser­vices De­part­ment re­leased Wed­nes­day were, as ex­pec­ted, dis­mal. Roughly 106,000 people have picked an in­sur­ance plan (they haven’t ne­ces­sar­ily paid their first premi­um yet) through one of the health care law’s new in­sur­ance ex­changes. An­oth­er 396,000 people have been ap­proved for Medi­caid be­ne­fits, ac­cord­ing to HHS.

That’s far short of where en­roll­ment ought to be at the end of the first month.

Re­pub­lic­ans were happy to high­light the ad­min­is­tra­tion’s en­roll­ment prob­lems, while the White House shrugged and said we all knew this was com­ing. The first month’s num­bers can tell us only so much about the law’s fu­ture, but the fig­ures do provide a couple of clear in­dic­a­tions about what’s work­ing — and what isn’t:

HHS is be­hind sched­ule, but there’s time to catch up.

The num­bers HHS re­leased Wed­nes­day are kind of use­less, largely be­cause it’s so early in the pro­cess. The first month’s en­roll­ment num­bers were nev­er go­ing to de­term­ine wheth­er the Af­ford­able Care Act lives or dies. Be­fore the re­lease, health care ex­perts agreed that the Oc­to­ber en­roll­ment fig­ures would help an­swer one ques­tion: Just how far be­hind are we? The an­swer: Pretty far.

HHS made two ar­gu­ments to down­play the Oc­to­ber num­bers: En­roll­ment was al­ways go­ing to be low in the first month; and, ob­vi­ously, it was go­ing to be low with such a badly broken web­site. Both are true, as far as they go.

HHS set a goal, be­fore the web­site launched, of en­rolling 500,000 people in the first month. It set that goal for a reas­on — that’s what it would re­quire to be on track to hit 7 mil­lion sign-ups over the next six months. So, ex­pect­a­tion-set­ting from the past month aside, the ad­min­is­tra­tion is still only 20 per­cent of the way to where of­fi­cials said it would need to be.

There’s still time to catch up. Most ex­perts agree that if the web­site is fixed by the end of the month, the law can still hit its over­all tar­get of en­rolling 7 mil­lion people, or at least get close enough.

Health­Care.gov is ter­rible.

The fed­er­al gov­ern­ment is run­ning the in­sur­ance ex­changes in 36 states. Yet it pulled in a paltry 25 per­cent of the first month’s en­roll­ment totals.

Only 14 states and the Dis­trict of Columbia are run­ning their own mar­ket­places, but they’re blow­ing past the fed­er­al gov­ern­ment so far — more people have en­rolled in Cali­for­nia alone than in all 36 states that rely on Health­Care.gov. And Health­Care.gov cov­ers some very big, very im­port­ant states. Texas and Flor­ida, the primary tar­gets in the ad­min­is­tra­tion’s out­reach cam­paign, en­rolled only about 6,500 people between them.

It’s cer­tainly no sur­prise that the web­site is ter­rible. It’s been ter­rible since its Oct. 1 launch, and it is no­tice­ably less ter­rible now than it was then. But it still has a long way to go, and it has to ac­tu­ally work for the en­roll­ment pro­cess to make up the ground it lost in Oc­to­ber. HHS of­fi­cials re­peated their as­sur­ances today that the site would be “work­ing smoothly for the vast ma­jor­ity of users” by the end of the month. If it’s not, this bad news will get much worse.

People are still shop­ping.

Not many people have picked a plan yet, but a lot of people could still be shop­ping. More than 1 mil­lion people have ap­plied for private cov­er­age through the law’s ex­changes and been deemed eli­gible — and 975,000 of them haven’t se­lec­ted a plan.

There are many pos­sible ex­plan­a­tions. That fig­ure in­cludes people who (suc­cess­fully) tested out the site without really in­tend­ing to buy cov­er­age. And some of those eli­gible in­di­vidu­als might not buy a plan at all, if the costs are too high. But HHS is con­fid­ent that a de­cent num­ber of those 975,000 people are simply still shop­ping, and will pick a plan even­tu­ally. Roughly one-third of the eli­gible pop­u­la­tion is also eli­gible for tax cred­its to help cov­er the cost of their premi­ums.