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Enrollment Studies Paint Mixed Picture of Marketplace Success So Far

By John Reichard, CQ HealthBeat Editor

January 9, 2014 -- Two new studies monitoring the traffic on the new insurance exchanges that opened up under the health care law provide ammunition for both its supporters and critics.

They show that a growing number of Americans are going to the online sites and are signing up for coverage, particularly in states that are gung-ho about the health care law (PL 111-148, PL 111-152).

On the other hand, they also show that enrollment so far is relatively tiny in many states hostile to the law, and that people with canceled policies who are given a chance to stick with those plans are doing so in many cases. That could be a problem for the marketplaces if those people are disproportionately good insurance risks whose relatively low costs would help keep coverage in exchanges affordable, had they obtained 2014 coverage there instead.

About one-quarter of Americans potentially eligible for health coverage on exchanges under the health care law had visited them by December, up from 17 percent in October, the Commonwealth Fund reported last week.

Two of every five visitors through December—41 percent—were in the 19 through 34 age bracket. Overall, 77 percent of marketplace visitors said they were in excellent, very good, or good health, the fund said.

The survey was carried out from Dec. 11 through Dec. 29.

Telephone interviews of 2,592 people of ages 19 to 64 were completed, of whom 622 fell into the category of lacking insurance, having bought it on the individual market, or having bought a policy on an exchange. The 622 included adults without insurance, those who purchased coverage on their own in the individual market, and those who said they bought a plan on an exchange.

"It is encouraging to see a greater share of those who could get coverage visiting the marketplaces, particularly the large share of visits by young adults and people in good health, since their participation will be critical to the marketplaces' success over time," said lead survey researcher Sara Collins, a Commonwealth Fund vice president.

On the other hand, visiting the marketplace is one thing, signing up is another.

Another finding from the survey was that 60 percent of all adults with individual coverage said that their insurance carriers had offered them the option of renewing their plans through 2014, and 82 percent of those said they planned to keep their current plan.

About one-third of those potentially eligible for coverage in new private plans or expanded Medicaid were unaware of the new marketplaces as places they might shop and almost half didn't know that financial help to buy coverage is available under the law, underscoring the importance of health care law promotional efforts that Congress has refused to fund.

Another study, by Harvard sociology professor Theda Skocpol, found that the health care law is working quite well in states that are fully behind it but that most states do not fall into that category.

Skocpol determined what percentage enrollees in Medicaid or private plans through the marketplaces made up of the number projected by the Kaiser Commission in the case of Medicaid and the Congressional Budget Office in the case of enrollments in private plans offered on exchanges.

"Full-go" states that were expanding Medicaid and running their own exchanges were doing quite well. Enrollments in those states totaled 43 percent of the goal set by the Kaiser Commission on Medicaid and the Uninsured and the State Children's Health Insurance Program, with the open enrollment period still having through March 31, 2014 to run. And enrollment in those states totaled 37 percent of CBO projections for private plan enrollment. But there were only 14 such states.

Other states had far lower percentages of enrollment against these benchmarks. They included 23 "just say no" states that refused to expand Medicaid or to officially cooperate with the federal exchange, Skocpol said.

The 23 had Medicaid enrollment totaling only 1.5 percent of the Kaiser goals. and private plan enrollment totaling just 6 percent of the CBO projections.

The enrollment picture was somewhat better in the 13 states that fell somewhere on the spectrum between full cooperation and full resistance, though the 'tweener states had a long, long way to go to meet the benchmarks.

"My analysis reveals that major progress is already happening in 14 "full-go" states, where officials are expanding Medicaid and running their own exchanges," Skocpol wrote. "Enrollments are happening more slowly in states where leaders accept all or part of reform but rely on the federal website and were hindered by its start-up woes," she added. "Across the board, enrollments are minimal in states where authorities refuse to expand Medicaid or encourage exchange enrollments."

Skocpol said her findings show that it is wrong to declare the law a failure. She said it's notable that the health care law "is moving forward the most rapidly and substantially in the states where officials wholeheartedly support reform," and that the best way to track its success is by "comparing states acting in good faith to those engaged in delay or obstruction."

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