Wednesday, November 13, 2013

Preliminary Thoughts on the New ACA Enrollment Figures

Figures released Tuesday by the federal Department of Health and Human Services confirm what everyone has been assuming for the last few weeks – that the number of people who have completed the process of signing up for insurance is far less than supporters of the Affordable Care Act had initially hoped for. Yet the figures are considerably better than I feared, considering the very rocky rollout of the online application portal.

Here are some of the highlights from the national data in the report covering the period Oct. 1 to Nov. 2:
  • More than 864,000 applications were completed, for coverage of almost 1,510,000 individuals.
  • Among the more than 1.5 million individuals with completed applications, more than 1,081,000 (72%) were found eligible for coverage through a Marketplace plan, including 326,000 who are eligible for subsidized Marketplace coverage.
  • About 396,000 people were found to be eligible for Medicaid or CHIP.
  • Among the nearly 1.1 million people determined to be eligible for Marketplace coverage, thus far only about 106,000 (10%) have selected a Marketplace plan.
Not surprisingly, there are significant differences between the data from the states running the Marketplaces themselves and the states relying on the federal Marketplace.  However, in a couple of respects I think the differences aren’t as dramatic as I had anticipated. Here are a few key points:
  • The 14 states (plus the District of Columbia) that are implementing their own Marketplaces account for 34% of the people for whom applications have been completed, which is less than I would have guessed after the slow federal start, and they account for just 27% of the people found eligible for Marketplace subsidies.
  • On the other hand, those states account for 54% of people found eligible for Medicaid or CHIP, and 75% of the people who by Nov. 2 had selected a Marketplace plan.
  • Among those who were found eligible for Marketplace coverage, in the state-run Marketplaces 21% had selected a plan by Nov. 2, compared to just 3.8% in the federal Marketplaces.
The new dataset from HHS includes state-by-state numbers, and after analyzing the Wisconsin numbers, I think there a few things that are noteworthy:
  • About 64% of the roughly 34,700 Wisconsinites for whom applications have been completed are eligible for the Marketplace.
  • About 10,700 or 34% were found to be eligible for BadgerCare.
  • Among the 22,000 eligible for the Marketplace, 40% qualify for federal subsidies, but thus far only 877 or 4% have selected a Marketplace plan.
It’s tempting to speculate about some of the differences between states, but at this early stage in enrollment I don’t think that’s a very productive endeavor.  However, I do think it’s important that the percentage of Marketplace-eligible applicants who have selected a plan is more than 5 times higher in the state-run Marketplaces than in Wisconsin and other states with federally-run Marketplaces.

That difference in getting applicants to the finish line might simply reflect that some of the state-run Marketplaces were able to get the online process operating more quickly and have had a head start in enabling applicants to use the online application process. Another possible factor may be that the states running their own Marketplaces have more Navigators who can help people complete the enrollment process.  In any case, I think the figures illustrate the important point that there are time lags at various stages of the process -- which is one of the reasons why I don't think it's realistic to expect to move many of the more than 77,000 current BadgerCare participants through the enrollment process by December 15. 

The HHS report provides some interesting comparisons of the slow early enrollment in the Marketplace with the lethargic early start-up months for CHIP, Medicare Part D, and the Massachusetts reforms.  Read more here.

Jon Peacock

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