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Thursday, October 27, 2016

by Charles Ornstein, ProPublica.

The first half of the Obamacare open enrollment period is over, and yesterday, federal health officials announced signup figures from the first three months.

After a disastrous start, (which handles enrollment for 36 states) began functioning properly. It, along with state-run insurance exchanges, netted more than 2.1 million signups between Oct. 1 and Dec. 28.

But are signups on pace to meet the Congressional Budget Office’s projection of 7 million this year? And is there an adequate balance between young and old, sick and healthy, to keep costs in line? That’s harder to say.

Here’s what we know:

  • Some states are performing much better than others. Connecticut has already exceeded the target the Centers for Medicare and Medicaid Services (CMS) wanted it to have by the end of March, according to New York and Rhode Island are also on pace to beat expectations. But other states are lagging. They include Maryland, Oregon and Massachusetts, which run their own exchanges and continue to be plagued by website problems. Also far behind are New Mexico and Mississippi, which rely on
  • Enrollees are skewing older. Currently, 33 percent of enrollees are 55 to 64 years old, compared to only 30 percent who are under 35. In Arkansas, Maine, Ohio, West Virginia and Wisconsin, at least 40 percent of enrollees are over 55. A higher proportion of younger enrollees are going to have to sign up before the end of March in order to help offset the costs of older ones. CMS officials say younger enrollees tend to sign up later in the process, as they did several years ago when Massachusetts implemented its individual mandate.
  • The vast majority of those signing up qualify for financial assistance. About 79 percent of the early signups will receive financial assistance, just a bit less than what the Congressional Budget Office estimated (86 percent 2013 see page 3). That ranges from an implausible low of 9 percent in Washington D.C., to 100 percent in Oregon.

Here’s what we don’t know:

  • How many of those who signed up for coverage previously had plans canceled by insurance companies. If the policies are merely replacing coverage that individuals already had, the law won’t make the dent in the uninsured that proponents hoped for. In New York, for example, only 44 percent of the early enrollees had been uninsured.
  • The health status of early enrollees. While some people consider age a proxy for health status, in truth, it isn’t a very effective stand-in. Experts say they need to know more about the health of those who enrolled to know if the insurance risk pool will be balanced, keeping premiums from exploding in the years to come. Health insurer Humana reported last week that the mix of its early enrollees was “more adverse than previously expected,” in part because the Obama administration gave those with canceled policies the ability to stay in them for another year. That assumes those who chose to stay were healthier than others.
  • Whether enrollees have paid their first month’s bill. Coverage does not take effect until consumers pay their initial bill. There has been plenty of confusion about the deadline to sign up — and confusion about when the first payment is due. Dates have changed and vary from state to state, insurer to insurer. Some insurers set a deadline of January 10; others have set different dates in January for coverage that began January 1. “It’s been pulling teeth,” Shaun Greene, chief operating officer of Utah-based Arches Health Plan, told the Wall Street Journal. The newspaper reported that as of Thursday, Arches had collected about 60 percent of premiums for people who signed up for coverage that took effect January 1.
  • How many people have signed up for coverage outside of the exchanges. In order to receive a premium tax credit to offset the monthly cost of coverage, individuals have to sign up using one of the health exchanges created under the law. But those who do not qualify or don’t want to bother can sign up directly with an insurance company. Ultimately, those figures will be publicly reported, but that will take months, or even years.
  • Will the open-enrollment period close strong, as it did in Massachusetts? Supporters of the Affordable Care Act regularly point to the experience of Massachusetts, which implemented a similar individual mandate in 2007, and saw a late surge of enrollment, particularly among the young. The open enrollment period for Obamacare runs through March 31, leaving plenty of time for folks to sign up.

AFP Photo/Karen Bleier

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  • daniel bostdorf

    Got to wait and see….informative statistics, but the ACA and sign ups has a long way to go…as a Massachusett’s resident, I can tell you that it takes time, and now, after 7 years, it is the best health care system in any state…

    • Independent1

      Yes, these early evaluations aren’t really worth much and often don’t help because they set a negative tone, for virtually any rollout that has months to the deadline. Here is something on that from an article in the Huffington Post:

      Obamacare Rollout-Rescue Model Seen in Romney’s Massachusetts

      The flaws plaguing the rollout of President Barack Obama’s health-insurance exchanges may matter the least to those the president needs the most.

      If enrollment in the online marketplaces repeats the pattern set in the Massachusetts exchange that was the model for Obamacare, the young people vital to the plan’s financial stability are paying little attention to the federal website’s mishaps as they wait for the March 31 deadline to sign up.

      When Massachusetts started its health-insurance exchange in 2007, younger and healthier people were the most likely to procrastinate until the final weeks to obtain coverage. By November of that year, the last month to sign up to avoid a penalty, the portion of enrollees age 35 or younger had more than doubled to 36 percent from February, one analysis showed.

      “The young and healthy are going to be the last to enroll,” said Michael Perry, a partner at PerryUndem Research, which has done market analysis for Planned Parenthood and the Robert Wood Johnson Foundation on the new exchanges. “Who knows, in February, when they’ll probably start getting around to this, or March, what the story will be?”

  • elw

    I had to stop reading this article half way through simply because I am really tired of Obamacare articles that focus on the unknown as a negative spin. It is time to stop using any excuse to talk about possible failure of the ACA, if for no other reason than it is here to stay in spite of its shortcoming and problems and because there are millions of Americans who would be literally thrown under the bus if does not work. The failed website showed that anything can be fixed which would include rules and policies that are not working. Medicare, the most popular and successful public healthcare program, has been tweaked constantly since it was passed. Imagine what would have happened to seniors you know today if they had just thrown the whole program away with the first problems they faced. But the biggest reason to stop acting like every issue is precursor to failure is this is a National program that is bigger than just its individual parts and it is only just 3 months old. Give us all a break, the Obamacare failure, disaster, illegal stories have cause enough stress already and now they are likely to begin hurting millions of Americans personally as they start using the program to access health care services. Recent news has not been negative stop trying to show otherwise: increasing enrollment is positive and if Medicare can produce a good balance between healthy and sick people who pay their premiums so can the ACA. How about more stories on how to use the program and what to do when you have problems with it? Seems to me that would be more useful than gloom and doom.