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Early Data Shed Light on Enrollment Through Federal, State Marketplaces

Early Data Shed Light on Enrollment Through Federal, State Marketplaces

November 13, 2013 — As of last week, slightly fewer than 50,000 U.S. residents had enrolled in health plans through the federal health insurance marketplace, according to two people familiar with internal government data, the Wall Street Journal reports.

Since its launch on Oct. 1, technical glitches and design problems with the federal marketplace -- HealthCare.gov, which serves residents in 36 states -- have caused the portal to crash several times for hours at a stretch, preventing consumers from completing coverage applications.

According to the Journal, the sources said that private insurers have received enrollment data for between 40,000 and 50,000 consumers who used HealthCare.gov, or about one-tenth of the administration's initial enrollment goal for the federal marketplace. The sources noted that the data reflect information sent directly by the website to insurers and exclude those who used the site to enroll in Medicaid.

HHS spokesperson Erin Shields Britt on Monday declined to confirm the numbers cited by the Journal's sources, noting that officials still expect most people to sign up later. Shields Britt said, "We have always anticipated that initial enrollment numbers would be low and increase over time, just as was the experience in Massachusetts, where only 0.3%, or 123 people paying premiums, enrolled in the first month." She added, "And, as we have said, the problems with the website will cause the numbers to be lower than initially anticipated" (Weaver et al., Wall Street Journal, 11/11).

How HHS Will Calculate Enrollees

Meanwhile, an administration official on Monday confirmed that the federal enrollment data will include individuals who have already purchased coverage, as well as individuals who have selected their plans but not made a payment, the Washington Post's "Wonkblog" reports.

The official -- who asked to be unidentified -- said, "In the data that will be released this week, 'enrollment' will measure people who have filled out an application and selected a qualified health plan in the marketplace."

By contrast, insurers do not consider a consumer as an enrollee until they have submitted a payment. The official said the administration intends on releasing data on such consumers because that is where the typical consumer's interaction with the federal website ends. According to "Wonkblog," insurers -- not the federal government -- are responsible for collecting the first month's payment from consumers (Kliff, "Wonkblog," Washington Post, 11/11).

State Marketplace Enrollment Numbers

As of Sunday, about 3% -- or 49,100 -- of the estimated 1.4 million people who are expected to purchase coverage through 12 of the state-run health insurance exchanges had enrolled in a plan, according to an analysis by Avalere Health, The Hill's "Healthwatch" reports (Viebeck, "Healthwatch," The Hill, 11/11).

According to the Washington Post's "Wonkblog," Avalere analysts worked backward from the Congressional Budget Office's projection that seven million people would sign up for coverage through the federal and state marketplaces in 2014 (Kliff, "Wonkblog," Washington Post, 11/11). The analysis did not include enrollment for the exchanges in California, Massachusetts and Oregon, "Healthwatch" reports ("Healthwatch," The Hill, 11/11).

Avalere CEO Dan Mendelson said a "climate of scrutiny and negativity" might have suppressed initial enrollment interest, but he added that sign-ups likely will "grow over time" (Howell, Washington Times, 11/11). According to "Wonkblog," most health policy experts offered similar observations, noting that enrollment figures would increase as the Dec. 15 deadline approaches for coverage to take effect on Jan. 1, 2014 ("Wonkblog," Washington Post, 11/11).

However, Mendelson added that the enrollment numbers would be low if consumers opt to pay the individual mandate penalty instead of purchasing insurance. Conversely, if states adopt the Arkansas Medicaid expansion model -- which enables the state to use federal funds to help residents purchase private insurance through the state's exchange -- enrollment in those states' exchanges would increase (Washington Times, 11/11).

"Wonkblog" also noted that Avalere's data might be imprecise because states report their enrollment figures differently. For example, Rhode Island included Medicaid enrollment figures in its enrollment totals ("Wonkblog," Washington Post, 11/11).