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Wednesday, October 26, 2016

by Charles Ornstein, ProPublica

This story was co-published with NPR’s “Shots” blog.

For months, journalists and politicians fixated on the number of people signing up for health insurance through the federal exchange created as part of the Affordable Care Act. It turned out that more than 5 million people signed up using by April 19, the end of the open-enrollment period.

But perhaps more surprising is that, according to federal data released Wednesday to ProPublica, there have been nearly 1 million transactions on the exchange since then. People are allowed to sign up and switch plans after certain life events, such as job changes, moves, the birth of a baby, marriages and divorces.

The volume of these transactions was a jolt even for those who have watched the rollout of the ACA most closely.

“That’s higher than I would have expected,” said Larry Levitt, senior vice president for special initiatives at the Kaiser Family Foundation. “There are a lot of people who qualify for special enrollment, but my assumption has been that few of them would actually sign up.”

The impact of the new numbers isn’t clear because the Obama administration has not released details of how many consumers failed to pay their premiums and thus were dropped by their health plans. All told, between the federal exchange and 14 state exchanges, more than 8 million people signed up for coverage. A big question is whether new members will offset attrition.

ProPublica requested data on the number of daily enrollment transactions on the federal exchange last year under the Freedom of Information Act because the Obama administration had declined to release this information, a key barometer of the exchange’s performance, to the public. The administration also has not put out any data on the exchange’s activity since the open enrollment period ended.

The data shows so-called “834” transactions, which insurance companies and the government use to enroll new members, change a member’s enrollment status, or disenroll members. The data covers the 36 states using the federal exchange, which include Texas, Florida, Illinois, Georgia and Michigan.

When rolled out last fall, insurance companies complained that the information in the 834s was replete with errors, creating a crisis at the back end of the system.

Between April 20 and July 15, the federal government reported sending 960,000 “834” transactions to insurance companies (each report can cover more than one person in the same family). That includes 153,940 for the rest of April, 317,964 in May, 338,017 in June and 150,728 in the first 15 days of July. The daily rate has been fairly stable over this period.

It was not immediately clear how many of the records involved plan changes or cancelations and how many were for new enrollments.

An insurance industry official estimated that less than half of the transactions are new enrollments. The rest are changes: When an existing member makes a change to his or her policy, two 834s are created — one terminating the old plan and one opening the new one.

Charles Gaba, who runs the website that tracks enrollment numbers, estimates that between 6,000 and 7,000 people have signed up for coverage each day on the federal exchange after the official enrollment period ended. Gaba’s predictions were remarkably accurate during the open enrollment period.

“That doesn’t account for attrition. That doesn’t mean that they paid,” Gaba said. “That’s been based on limited data from a half dozen of the smaller exchanges, extrapolated out nationally.”

The federal data obtained by ProPublica confirm some other facts about the rollout of, which was hobbled initially by technical problems. The slowest day was Oct. 18, when no 834 transactions were sent. That was followed by Oct. 1, the day the website launched, when a grand total of six records were sent to insurers.

By contrast, the busiest day was March 31, the official end of open enrollment, when 202,626 “834” reports were sent to insurers. The entire last week in March was busy.

About 86 percent of those who signed up for coverage on the federal exchange were eligible to receive government subsidies to help lower their monthly premiums. Those subsidies are being challenged by lawsuits in federal court contending they aren’t allowed by the Affordable Care Act.

Two federal appeals courts came to conflicting decisions Tuesday on the permissibility of the subsidies (one said yes; the other no). They will remain in effect as the cases proceed in the courts, the Obama administration said.

The next time that the general public can sign up for coverage through the exchanges is from November 15 to February 15, 2015.

Click here to download the data (Excel or CSV) released to ProPublica under the Freedom of Information Act.

Read our previous coverage of the Affordable Care Act and share your story.

AFP Photo/Joe Raedle

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  • Dominick Vila

    The fact that thousands of Americans continue to buy health insurance policies via the ACA exchanges is not surprising. ACA was not designed to be a one-time shot. People who had employer-provided insurance coverage a few months ago, and who for a variety of reasons no longer have it, are taking advantage of affordable coverage offered by the ACA. The same goes for young people whose employers don’t offer healthcare coverage. Instead of going to Emergency Rooms when they are seriously ill, and taking advantage of Reagan’s law to avoid paying for the services they get, they can now buy health insurance via the ACA exchanges that offer complete coverage, including preventive medicine. For this segment of our population, which usually make below average wages, the benefit of subsidies, the subsequent affordability, and the knowledge that they will not become a burden on their parents and society, is irresistible.
    People like those cited above are among the potential victims of Boehner’s lawsuit and recent Appeals Court decisions.

    • Independent1

      The fact that there are conservative groups pushing a lawsuit to disallow the insurance subsidies to people in states which didn’t create their own exchanges, is just more evidence, to me at least, as to just how heartless and evil conservatives have become. The 24 red states are already putting millions of their resident’s lives at risk by refusing to expand Medicaid – with a projected 17,000 to die prematurely this year because of that; and then here come conservative groups pressing lawsuits to potentially push hundreds of thousands more low income people off of insurance who can’t afford the insurance without the government subsidies; for nothing more than some ideological idiocies these groups feel justified in letting possibly thousands more die prematurely. And many of these conservative Republicans have the audacity to call themselves Christians??? Well, they’re nothing more than the Devil’s henchmen!!!

      • dtgraham

        Republicans simply believe that health care is not a human right that wealthier nations should insist all of their citizens have. They see it as just another good or service in the marketplace that you can either afford or you can’t; or perhaps you can afford some of it but not as much as you need. If you can’t afford health insurance (thus healthcare) then you should have worked harder or you should have made more money or you should have been more successful or you should have done this or you should have done that. It’s strictly an individual matter to them, and people dying or going bankrupt from lack of health insurance is not a concern. It’s a unique world viewpoint on healthcare and that’s as kind as I can put it.

        Look at their attempts to turn Medicare into a private market coupon program. You also see their constant yelling to send Medicaid back to the states with block grants and no strings attached. Take a look at the absurdly low income cut off for Medicaid in some of those states. To qualify for Medicaid in Kansas you can’t make more than $7700.00 in a year (I think). In their hearts (pardon the use of the word) they want those things gone too.

        They like to go off into the weeds with esoteric arguments and fallacious, meaningless statements about lawlessness, train wrecks, death panels, socialism, keep your doctor, and so on…but it really comes down to just ideology as you put it. It has nothing at all to do with effective public policy.

  • charles king

    Health care is about the welfare of the People that is What? Democracy is all about so Why? are we having this problem of Not being used. I go back to FDR days When? the People believed in their Democracy and they started their Unions, Social Securities, Medicare things for the People and these are the things that are working today so do not let (Capitalistic Pigs, Big Wigs of Corporations, Plutocracts Who? are privatizing your assets,Do-Nothingers Representives, Republicans, and Democracts of all shades, Etcs.) the VOTE is still Supreme, so VOTE their Sorry A**** OUT OUT OUT. Thank You are the magic words in my book. I Love Ya All. Mr. . E. KING

  • exdemo55

    Voters got to know Jonathan Gruber in 2012 when the Obama campaign put the health care policy wonk forward to shut down ObamaCare attacks from Republican nominee Mitt Romney. President Obama was so eager to play up Gruber’s role as a chief architect of ObamaCare because Gruber had been a chief architect of Romney’s state-level health law. Elevating Gruber allowed the campaign to deliver his lines with greater crack: “The core of the Affordable Care Act or Obamacare and what we did in Massachusetts are identical,” says Gruber in one campaign ad. While Gruber may have helped neuter Romney’s ObamaCare attacks, he may end up helping to neuter the law itself thanks to a video unearthed by free-market think tank the Competitive Enterprise Institute.

    Gruber, an MIT professor who has become a Democratic health care talking head, also gets paid for talking to industry groups about ObamaCare. In one 2012 speech, Gruber talked about the provision in the law that has state governments administer enrollments, including subsidies. “I think what’s important to remember politically about this is if you’re a state and you don’t set up an exchange, that means your citizens don’t get their tax credits,” said Gruber, a MIT professor, in a speech two years ago. Why is that problematic? Because it directly contradicts what the administration argued in court about a lawsuit that could be “devastating” to ObamaCare because it would end the subsidies paid to enrollees in the states that did not voluntarily comply.

    The preferred talking point for pro-administration groups has been to dismiss the subsidy gap as a clerical error, not an intentional policy. It goes like this: Congress meant to provide a way to work around non-compliant states, but didn’t get the wording right. It was, in the words of one administration insider deployed to knock down the court decision, a typo. And who was that insider? You guessed it: Jonathan Gruber. This matters not because it is an embarrassing deception for an academic to be caught in, but because it suggests the falsity of the administration’s claim that this was a glitch and not a feature. The administration was eager to highlight Gruber’s role in order to shame Romney, making it hard now to suggest that he was some peripheral figure. Whether this matters in the expected Supreme Court decision is a matter for the legal eagles to consider, but from a messaging point of view this is a Krakatoa-sized eruption.

    The plan pretty plainly was to do on subsidies what the administration has tried to do on Medicaid expansion: pressure governors who do not comply and create talking points for Democratic candidates. It’s just that so many states refused to set up their own ObamaCare shops, including those with supportive governors. The rest of the actual glitches in the law and technology made even some liberal governors opt out and kick the can back to Washington. If the White House can’t argue publicly that this is some silly technicality it goes straight to the heart of the main problem with ObamaCare and voters: they don’t think it works.

    A very troublesome agency – WSJ’s Kimberly Strassel points out that the agency behind the regulation that may sink ObamaCare is the same one that has left the administration embroiled in a political scandal: “The IRS (famed for nitpicking and prosecuting the tax law), chose to authorize hundreds of billions of illegal subsidies without having performed a smidgen of legal due diligence, and did so at the direction of political taskmasters. The agency’s actions provided aid and comfort to elected Democrats, even as it disenfranchised millions of Americans who voted in their states to reject state-run exchanges. And Treasury knows how ugly this looks, which is why it initially stonewalled Congress in its investigation—at first refusing to give documents to investigators, and redacting large portions of the information.”

    New round of ObamaCare delays, waivers : “The Obama administration is coming under fire for once again making a unilateral change to ObamaCare — this time, quietly exempting the five U.S. territories and their more than 4 million residents from virtually all major provisions of the health care law. The decision was made a week ago, and was a long time coming. For months, the territories have been complaining that the law was implemented so poorly in their regions that it destabilized their insurance markets. Until now, the Department of Health and Human Services claimed its hands were tied. But last Wednesday, the department reversed course. The about-face has some questioning the department’s authority to suddenly grant 4.1 million Americans an out from ObamaCare. …”