Just 364,682 Americans picked a health insurance plan through President Obama’s health care program between the Oct. 1 launch of the insurance exchanges and Nov. 30, the Department of Health and Human Services announced today.
Though the pace of signups accelerated during November, as only 106,185 Americans had picked plans as of Nov. 2, the combined signups were still less than half the administration's target of 800,000 enrollments by the end of November.
Adding a caveat, HHS noted that it is trying to correct a problem that may have resulted in some of the signups being counted twice, thus potentially overstating the number.
The “duplication” issue applied to numbers coming from some of the 14 state-based exchanges, which were responsible for 227,478, or 62 percent, of the signups. The remaining signups came through the federal exchange, which serves 36 states through the troubled healthcare.gov website. HHS said federal data had been scrubbed of duplicates.
As it has done previously, HHS defined people as “enrolled” if they went through the process of filling out an application and selecting a plan, but officials still have not released data on how many individuals actually paid their first month’s premiums, which is the traditional way that insurers define enrollment.
Individuals have until Dec. 23 to pick plans and until Dec. 31 to pay premiums for policies that go into effect on Jan. 1. By that time the administration had originally projected 3.3 million Americans would enroll in insurance through the exchanges, according to an internal HHS document unearthed by the Associated Press.
That means more than 2.9 million signups are required for December to catch up to the original target pace, an ambitious goal even assuming a better-functioning website, a stepped-up outreach effort and lot of Americans waiting until the last minute to decide on a plan.
The Congressional Budget Office had projected that 7 million Americans would enroll by the end of open enrollment March 31.
Many health care writers have noted that the total number of enrollments is less important than whether the exchanges have a critical mass of younger and healthier participants to offset the cost of older and sicker enrollees. Though this is true, it’s also true that the lower the overall enrollment number, the less likely it is that the exchanges will have enough healthy participants to support a wide variety of plans.
HHS has not provided a demographic breakdown of those who have selected a plan.
It’s worth keeping in mind that it isn’t merely a matter of gaining a critical mass of healthy enrollees nationally, but in each individual state. And right now, there is a wide disparity about how states are performing.
On the one hand, California has signed up 107,087 and New York has signed up 45,513. Thus, these two states are responsible for 42 percent of signups despite accounting for around 19 percent of the nation's population.
In contrast, 11 states had fewer than 1,000 signups apiece. The worst performing state, Oregon, signed up just 44 people despite spending more than $300 million building and promoting its exchange. HHS did not release data for the District of Columbia.
In addition to the enrollments in plans through the exchanges, HHS reported that 803,077 Americans had been deemed eligible for Medicaid. The CBO had projected that 9 million would be added to the Medicaid rolls in 2014, on top of the 7 million who were expected to obtain subsidized insurance through the exchanges.
The administration and its allies will no doubt spend today touting the faster pace of the signup numbers as evidence that the law is “working.” But that says more about the pitiful state of the exchanges in October than any subsequent success. Instead of allowing the administration to move the goal posts, any fair assessment of the exchanges would look at how the law is performing relative to its original goals. And by that metric, it began December in a deep hole.