By Rebecca Adams, CQ HealthBeat
November 11, 2013 -- The number of people who chose a plan in the new federal health care marketplaces was 26,794 people in the first month of open enrollment in October, matching the expectations of an extremely low participation rate. The statistics underscore how difficult it will be for Obama administration officials to live up to the hopes that they and their allies in the health care industry had for broader coverage starting in January.
The combined enrollment for the federal and state-based marketplaces was 106,185 from Oct. 1 through Nov. 2, Health and Human Services (HHS) officials announced last week. Of those, three-fourths—or 79,391 people—signed up through the 14 states and the District of Columbia, which are running their own marketplaces. The 26,794 people who enrolled in the federal marketplace are from 36 states.
The enrollment numbers reflect the number of people who applied and chose a plan, but some of them may not have paid for the coverage yet. People must pay their premiums by Dec. 15 if they want coverage to start on Jan. 1, the first day possible.
The number of sign-ups is in sharp contrast to the tens of millions of people who showed interest in the coverage. HHS officials said that there have been an estimated 26,876,527 visitors on the state and federal websites. In addition, an estimated 3,158,436 people called into state and federal call centers to get information about how to enroll.
The total number of people who took the first step of completing an application in either a state or federal marketplace was 1.5 million people. Only 326,130 of them were eligible for a subsidy. That raises the question of whether the rest will go on to enroll or whether they will find the coverage unaffordable.
The 1.5 million applications include 396,261 people who were believed to be eligible for Medicaid or the Children’s Health Insurance Program.
The Congressional Budget office predicted 7 million people would enroll in the first year of coverage and 9 million people would enroll in Medicaid during that time. This first year’s open enrollment period extends until March 31.
A Legacy Issue
President Barack Obama staked his reputation on a successful launch of his top domestic priority. The administration has lost a tremendous amount of political capital from the embarrassing rollout. Health care industry executives representing hospitals, insurers and others had accepted billions of dollars in lower payments because they believed millions more Americans would be able to pay for health care services under the law (PL 111-148, PL 111-152).
Administration officials say they have time to catch up, but the challenges are becoming increasingly difficult. The technical problems with healthcare.gov, the federal website responsible for enrolling people in 36 states, persist.
Administration IT officials said at a House oversight hearing last week that the website will “not be perfect,” as the administration’s chief U.S. technology officer Todd Park put it, after the administration’s self-imposed Nov. 30 for having the website’s biggest problems fixed.
But administration officials said that they are not yet worried that they will not meet their enrollment goals. HHS Secretary Kathleen Sebelius repeated the administration’s point that there are several ways for people to enroll besides the exchanges, either through the national call center or in person at an assistance center. She also emphasized that people who do not expect to be eligible for a subsidy can go directly to an insurer to enroll.
Sebelius also reminded reporters during a conference call last week that enrollment in other coverage programs, such as the one in Massachusetts that is the model for the health care law, began slowly and ramped up near the end.
On Capitol Hill, lawmakers had predictable reactions, with Republicans sharply criticizing the federal effort and Democrats either remaining quiet or defending the implementation as an exercise in steady progress.
Details on the Numbers
The 29-page HHS report includes a state-by-state breakdown of the data supplied to HHS from states and the federal marketplace.
In only two states were the majority of applicants found to be eligible for Medicaid rather than marketplace insurance coverage. Those states were Maryland and Washington, two states that are expanding the Medicaid program and had their own technical problems with enrollment in October.
That jibes with reports from several states where officials said that they did not see noticeable increases in applications for Medicaid in October.
But the HHS statistics may be limited and trends could change over time.
Separately, the state of California also released its own enrollment statistics on Wednesday. Those showed that nearly 60,000 Californians through Nov. 12 had selected a marketplace plan. Another 72,007 were determined likely to be eligible for Medi-Cal, the state Medicaid program.
On Tuesday, the state of New York said 48,162 people had signed up since Oct. 1 for marketplace insurance plans. The HHS data, which was compiled from earlier statistics, said 16,404 have enrolled in marketplace insurance and 23,902 had qualified for Medicaid.