The December Surge: What Does It Mean for Obamacare?

Now that the rush to beat the deadline for January 1 health insurance coverage has passed, analysts have had an opportunity to review and assess the progress of Obamacare. Has it been successful so far?

It depends on whom you ask.

The original goal for Obamacare sign-ups was 7 million, with the first 3.3 million people enrolling by December 31. Within those numbers, insurers were looking for 40 percent participation by people under age 35.

According to NBC News, about 85 percent of Americans are covered by an employer, Medicare, Medicaid, or their own private insurance. But 45 million Americans lack health insurance.1 The federal health exchange at Heathcare.gov offers coverage to residents in 36 states. The remaining states set up their own exchanges, such as Covered California. The results tallied so far from the federal health exchange and state exchanges are revealing and encouraging.

The 2013 Obamacare Results

More than 2.1 million people enrolled in health exchange insurance plans during the October through December 2013 window. Most enrolled during December, which saw a mad rush during the last week of sign-ups to be eligible for January 1 coverage. Throughout the three months, enrollments on state exchanges exceeded the federal sign-ups, with California and New York leading the way as expected.

However, December enrollments on the federal website numbered 1.1 million. Contrast this with only 27,000 during the problem-plagued October rollout. The turnaround is nothing short of amazing. Still, critics point out that the totals are only two-thirds of the numbers expected by the end of December.

Types of Plans Enrollees Purchased

Nationwide, the breakdown of the types of plans enrollees selected follows:

  • Bronze – 20%
  • Silver – 60%
  • Gold – 13%
  • Platinum – 7%
  • Catastrophic – 1%

These are averages. The breakdown varies state to state.2

California Obamacare Results

California led the nation in the number of enrollees. During the three-month sign-up period ending December 23, 2013, 498,794 Californians enrolled. Fifty-three percent were female, and 47 percent were male (54-46% female-male breakdown nationally). About 25 percent belong to the highly sought-after 18-to-34 demographic group. This age group constitutes about 24 percent of the California population.

More interesting statistics about California sign-ups:

 

Completed applications

766,682

Individuals applying in completed applications

1,410,359

Eligible to enroll in a marketplace plan

697,188

Eligible to enroll with financial assistance

529,013

Eligible for Medi-Cal or CHIP

181,817

Pending

531,354

Number Eligible Who Have Selected a Marketplace Plan

498,794

A little more than 49 percent of individuals who applied in the completed applications were eligible to enroll in a health exchange plan. About 76 percent of this group qualified for financial assistance (tax credit and possibly assistance with out-of-pocket expenses). Another 13 percent of the individuals “applying in completed applications” were eligible for Medi-Cal or CHIP. Approval for another 38 percent of the individuals with completed applications is pending.

Those in the Pending group either have not been assessed as eligible yet or have been declared ineligible but have the option of presenting an appeal.

The 498,794 who are eligible and have selected a Covered California plan have not necessarily paid their premiums yet.

Of those who have selected a plan, 61 percent chose a Silver plan. Eighty-five percent of them will receive financial assistance.3

Young Enrollees

Insurance companies need younger, healthier enrollees to keep down rates. Nationally, people under the age of 35 (ages 18-34) make up about 24 percent of enrollees. This matches their share of the population.4

However, these percentages vary by state. For example, in New York, 30 percent of the 230,000 enrollees through the state’s health insurance exchange were under the age of 35. Half of the people who enrolled in New York had been uninsured previously. The cost of individual coverage on the New York health exchange is 53 percent less than the individual coverage that was available last year.5

According to Health and Human Services Secretary Kathleen Sebelius, nationally, there was more than an eightfold increase of young adult enrollees in December. Contrast this with a fivefold increase for other age groups.6

Although the percentage of enrollees in the 18 to 34 group falls far short of the 40 percent target, a survey by the Commonwealth Fund finds reasons to be encouraged. It found that:

  • 24 percent of adults eligible for Obamacare coverage had visited an exchange by the end of December
  • 41 percent of visitors to health exchanges were between the ages of 19 and 34
  • 77 percent described themselves as in excellent, very good, or good health

Still, there are complaints from many in this age group that the policies offered are unaffordable. Only 37 percent of those surveyed in the Commonwealth Fund study said they found it “very easy” or “somewhat easy” to find a plan they could afford while visiting an exchange website. Many can still be covered on their parents’ plan until they are 26. But 59 percent of those surveyed said they intend to enroll in an Obamacare plan by March 31 if they had not already done so.7

If Massachusetts, which began a similar program several years ago, is any indication, the percentages of young enrollees could rise significantly (175% in Massachusetts) as we get closer to the end of the 2014 open enrollment date, March 31.8

Questions and Opportunities

The next set of numbers analysts and the public will examine closely include how many of the sign-ups actually paid their premiums to begin coverage. This could affect confidence and costs associated with the health plans.

Many believe that potential enrollees are waiting to see how new patients fare in getting the doctors, appointments, and treatment they want and need.

Analysts are sure to ask more questions about drop-off and conversion rates. Consider these:

  • Visits to the federal and state health exchange websites through the end of December 2013 numbered 53.2 million.
  • Another 11.3 million phoned health exchange call centers.
  • That’s potentially 64.5 million people expressing some level of interest in the health exchange insurance plans.9

Even given probable duplication in the numbers of inquiries to the health exchanges, these numbers reveal a strong interest in learning more about exchange plans.

What happened with these people?

From the period October 1 through December 28, 4.3 million completed applications were submitted. Only half, about 2.1 million people, are signed up. Are the other half still being processed? Did they drop out? Were they disqualified? What did we learn about the millions who made contact but never completed an application? What do these numbers tell us?

Clearly, there is still a lot to learn as we continue to encourage sign-ups by the March 31 open enrollment deadline for 2014.

Notes

1 http://www.nbcnews.com/health/deadline-looms-obamacare-2D11792133.

2 ASPE Issue Brief. January 13, 2014. Health Insurance Marketplace: January Enrollment Report. http://aspe.hhs.gov/health/reports/2014/MarketPlaceEnrollment/Jan2014/ib_2014jan_enrollment.pdf.

3 Ibid

4 Ibid

5 James T. Mulder. Nearly One-Third of New Yorkers Enrolled in Obamacare Are Under Age 35. http://www.syracuse.com/news/index.ssf/2014/01/nearly_one-third_of_new_yorkers_who_have_enrolled_in_obamacare_are_under_age_35.html.

6 Scott Horsley. Young People Account for a Quarter of Health Care Enrollees. http://www.npr.org/2014/01/13/262185902/young-people-account-for-a-quarter-of-health-care-enrollees

7 Dan Mangan. Obamacare Enrollment Healthier, with Room to Grow: Survey. http://www.cnbc.com/id/101320707.

8 Sy Mukherjee.Breaking: What the Newest Obamacare Numbers Mean for the Health Law. http://thinkprogress.org/health/2014/01/13/3153031/obama-administration-releases-obamacare-enrollment-demographics/.

9 ASPE Issue Brief. 

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