Thursday, July 24, 2014

Seven things we now know about Obamacare enrollment

Joe Raedle/ Getty Images

1. Exactly 8,019,763 people enrolled between October and April.

The Obama administration published a report Thursday that shows who signed up for private health plans during the health care law's first open enrollment period.

Obamacare_enrollment

That report shows that exactly 8,019,763 people enrolled in coverage between October and April. This figure represents everyone who went onto marketplace, picked a plan and had his or her information sent off to their insurance company (which subsequently mailed out a bill).

2. This is not the number of people who will have health insurance through the exchange this year.

People will shift off the exchange over the next 12 months – and others will shift on.

Some of the 8 million will not pay their first month's premium, so the insurance company won't start their coverage. Other people will stop paying their premiums in a few months – maybe because they got a job, or because they couldn't afford coverage anymore – and insurers will halt services.

People who aren't in the 8 million right now, will join the exchange. They might lose their job, for example, and go to healthcare.gov to buy coverage. There nine major life events, like leaving a job or moving states, that let people sign up for exchange plans when its not open enrollment.

"This is a very transitional market," says Larry Levitt, a senior vice president at the Kaiser Family Foundation. "Millions of people transition out of jobs every year and potentially could enroll in the marketplaces. There are real questions as to what people will do."

3. The individual market had lots of flux before Obamacare – and will have lots of flux after it.

Most people don't purchase their own health insurance for very long; individual plans are more typically used as a bridge between other sources of coverage, usually employer-sponsored insurance.

One recent study in the journal Health Affairs found that, prior to Obamacare, only two-thirds of those in the individual market kept their policy for more than four months. The number falls to 47 percent for people who kept their policy an entire year. Individaul_market_

That same level of turnover is likely to show up in the exchanges, too.

4. Enrollment looks really different from state to state.

There were huge gaps on how much each state spent on outreach. Some state exchanges, like Covered California and Washington Health Plan Finder, worked really well. Others, like Cover Oregon and (for two months) Healthcare.gov, didn't. That mattered for final enrollment numbers.

Obamacare_target_population_reached

5. Most people who have signed up for plans do seem to be paying their insurance bills.

Insurers say they're seeing about 80 to 90 percent of people who they send bills to send back a payment. Karen Ignagni, who runs America's Health Insurance Plans, recently ballparked it at 85 percent.

There's also a report from House Republicans using data from insurers showing that two-thirds of enrollees had so far paid their premiums. But insurers cautioned when they turned in that data that they were still waiting for more payments to come in and that these figures are not "final verified numbers."

One problem with the data in the Congressional report is it only runs through April 15–when some people were still signing up for coverage, or had just enrolled. These people had until the end of the month to pay their bill, so may have turned in their payment over the past two weeks.

"We're in a bit of a data-free zone right now," Levitt says. "We're forced to rely on anecdotal reports from insurers or a study from Energy and Commerce. It's a hard thing to study because its a moving target: there will always be more people signing up who haven't yet paid their premiums."

6. The exchanges aren't the only place where people are gaining coverage through Obamacare.

About three million young adults signed up for their parents' plan after health reform extended dependent coverage up to age 26 in 2010. Other people are getting covered through the health care law's expansion of Medicaid to everyone below 133 percent of the poverty line (about $15,000 for an individual).

Counting the exact number here is tricky. the Obama administration has said that 4.8 million people signed up for Medicaid since October, but hasn't specified how many of those people were newly-eligible for Obamacare's expansion. There are lots of people in that number who likely would have enrolled in Medicaid regardless of a massive health insurance expansion.

We do have some evidence though that Obamacare is responsible for a decent chunk of the 4.8 million sign-ups: Medicaid enrollment grew five times faster in states that expanded the program than those that didn't.

Medicaid_change

7. Is 8 million people signing up for private insurance a success? That's hard to say.

The number is higher than the 7 million people the Congressional Budget Office projected would use the exchange. The number could fall slightly below that target depending on how many people pay their premium: if Ignagni's estimate of 85 percentof customers paying holds true, for example, that would work out to 6.8 sign-ups.

You could see the 8 million as a proof-of-concept: there was a sizable audience of people who decided they wanted what Obamacare was selling. This wasn't taken as a given at the start of open enrollment, or even as recently as December, when health law sign-ups lagged far behind projections.

At the same time, there are lots of people without insurance who didn't sign up. Kaiser Family Foundation estimates 28 million people were eligible to buy coverage on the exchanges (this includes the uninsured, and those already buying coverage in the individual market).

About a quarter of them decided to. That still leaves another 20 million people who didn't purchase insurance – maybe because they didn't want to, or were confused, or never even heard there were options to begin with.

"CBO has enrollment ramping up next year to 13 million and that feels like a pretty big leap given how hard it was to hit 8 million," says Levitt.

The people who signed up in 2014 were likely the most motivated, the low hanging fruit for enrollment workers. The people who will be pitched in 2015 sat out the first round of sign-ups and, come next year, could be a tougher sell.

Live Q&A until 1 p.m.

Do you have question about Obamacare enrollment I didn't answer? Leave them for me below in comments! I'll be here until 1 p.m. responding.

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