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Administration Says Health Law Enrollment Spiked After End of Official Sign-Up Period

By Rebecca Adams, CQ Roll Call

May 1, 2014 -- About 900,000 people signed up for coverage in the new insurance plans created by the health care law after the official end of open enrollment on March 31, according to a federal enrollment report released late last week. The surge represented about 12 percent of the more than 8 million people who applied for coverage from Oct. 1 through April 19.

President Obama had previously announced the 8 million total on April 17. The 45-page report provides more details about the demographics and state-by-state breakdown of people who signed up, as well as the number who chose a plan after the official deadline.

The surge of sign-ups after March 1 accounted for almost half of the total enrollment from Oct. 1 through April 19. The administration had extended the sign-up period beyond the official March 31 deadline so that people who had trouble enrolling by that date would have more time.

About 85 percent of people who signed up during the entire sign-up period were eligible for federal subsidies.

About 28 percent of the total number of people signing up after Oct. 1 through April 19 were between the ages of 18 and 34 years old, compared to a cumulative 25 percent of the people who signed up from Oct. 1 through March 1. Supporters of the law and insurers had hoped that around 40 percent of the people who chose a plan would be young adults in order to offset the costs of covering older, sicker people.

On the other end of the age spectrum, about 25 percent of people who signed up during the full enrollment period were between 55 and 64 years old, which is a smaller percentage than the 30 percent of enrollees who signed up by March 1. Because insurers cannot ask people if they have medical conditions, age is being used as a proxy that will help officials estimate how many enrollees are healthy.

The Health and Human Services Department's (HHS) report did not include information on how many people have paid their first month's premium, which is a key step in getting covered. Individual insurance companies have said that about 10 percent to 20 percent of people have not paid to start their coverage.

Michael Hash, the director of the HHS Office of Health Reform, told reporters on a call that he expects insurance premiums next year to be stable "in every state," in part because of financial protections in the law that limit the losses of insurers and provide federal money to pay for the most expensive cases.

Health and Human Services Secretary Kathleen Sebelius said that the sign-up statistics are evidence that enrollment was "exceeding expectations and demonstrating brisk demand for quality, affordable coverage."

Much of the enrollment is driven by California residents. About 1.4 million Californians enrolled from Oct. 1 through April 19, according to the report.

Most U.S. residents chose the cheapest plans available. About 20 percent chose either the so-called bronze tier, which covers about 60 percent of the costs of care. About 65 percent chose the silver level of plan, which covers about 70 percent of costs. People whose income is less than two and a half times the federal poverty level also can get additional federal assistance paying their out-of-pocket costs if they choose a silver plan. The poverty level for a single person in 2013 was $11,490.

The report contains the first breakdown by race of individuals who signed up through the federal website, which handles enrollment for 36 states. About 69 percent of total enrollees used the website. Of those who voluntarily indicated their race or ethnicity, about 63 percent were white, almost 17 percent were African-American, almost 11 percent were Latino and almost 8 percent were Asian.

Roughly 54 percent of all enrollees were female and 46 percent male. In the past, insurers often charged women higher premiums on the grounds that they often have higher health care costs than men. The law bars different rates for women and men now.

The report also included the first federal statistics on the percentage of enrollees who were previously uninsured, although a federal official told reporters that the number was so high that it seemed "unreliable." Of the nearly 5.5 million people who chose a plan during open enrollment through the federal marketplace, about 5.2 million of them applied for subsidies and therefore had to answer a question about whether they had coverage. About 695,011 people, or 13 percent of subsidy applicants, said they did. But other independent surveys earlier this year indicated that somewhere between 50 percent and 73 percent of applicants already had coverage. New York state reported that 30 percent of applicants were insured and Kentucky officials have said 25 percent had coverage.

In addition to the 8 million people who signed up for coverage in the marketplace plans, the Congressional Budget Office estimated that about 5 million people will have coverage this year through individual market plans sold outside of the marketplaces. The insurance risk pool in each state is based both on the people who bought insurance through the marketplaces and outside of it.

NEW starts here: The administration also released partial Medicaid and Children's Health Insurance Program enrollment data. The report showed that, when compared to enrollment before the marketplace sign-up period started, more than 4.8 million additional people enrolled in Medicaid or the Children's Health Insurance Program from Oct. 1 through the end of March. The data are incomplete because not all states reported the same information and it reflects people who applied through state agencies such as state Medicaid divisions or state-run marketplaces.

"It's good news that more people are getting coverage," said Joan Alker, the executive director of the Georgetown Center for Children and Families. "One thing it shows is that when you create a welcoming atmosphere, it encourages those who are already eligible to sign up."
Another 1 million people had gained coverage through an early expansion of Medicaid to low-income adults in seven states before Jan. 1, 2014, federal officials said.

Many Democrats running for re-election have shied away from praising the law. But House Energy and Commerce senior Democrat Henry A. Waxman of California, who is retiring, said that the final enrollment report proves that the health care law "is a historic success."

The next open enrollment period for Americans to buy coverage through the law (PL 111-148, PL 111-152) is expected to run from Nov. 15 through Feb. 15. People can still sign up before if their circumstances change, such as a loss of health coverage or change in marital status. Many people also will be able to sign up earlier if they had trouble enrolling before April 15. Those individuals can ask to sign up through special enrollment.

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