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State-Run Obamacare Exchanges Signed Up More Than

Only 14 states are running their own insurance marketplaces, but they account for three-quarters of total sign-ups in the first month.

The Obama administration fell far short of its goal of signing up 500,000 people for insurance coverage through online marketplaces in its first month of operation, enrolling just 26,794 people through the glitch-ridden and another 79,391 through individual states running their own exchanges.

The release Wednesday from the Department of Health and Human Services is the first official look at enrollment data from Oct. 1 through Nov. 2, the first month of a signature portion of President Barack Obama’s health care overhaul. The 14 state-run marketplaces and the federal exchange that serves the 36 other states allow people without affordable coverage through their employer to shop for a health plan, often with tax credits if their income is low enough. The figures include state-by-state breakdowns of completed applications, eligibility for financial assistance or Medicaid, and the number of people who have actually selected a plan.

Other figures of note: 

  • About one million people have applied and been determined eligible for a marketplace plan. Of those, 326,000 are eligible for subsidies to defray the cost of insurance. 
  • About 400,000 people are eligible for Medicaid or the Children’s Health Insurance Program, with about half coming through the federal exchange. The federal exchange can't yet transfer those accounts to local state agencies for completion, so consumers have to contact agencies on their own. 
  • HHS did not break down enrollement numbers by age. The administration's goal is to sign up 2.7 million people between the ages of 18 and 35 to offset the risk of loading insurance pools with more sickly people, who drive up costs. Officials said demographic information will be included in future releases but didn't specify when. 
  • State exchanges accounted for about 75 percent of enrollment in the first month.
States with the highest enrollment were those that ran their own exchanges. California came in first with 35,364 new enrollees, followed by New York at 16,404 and Washington State at 7,091. Among states operating through the federal exchange, those with higher populations generally had higher enrollment. Florida topped that list at 3,571, followed by Texas (the state with the highest uninsured population in the country) at nearly 3,000 and Pennsylvania at 2,207. Bringing up the rear were Wyoming at 85 sign-ups, South Dakota at 58, Alaska at 53 and North Dakota with just 42 new enrollees.

The overall early enrollment figure of 106,000 includes both people who have paid initial premiums, which are due Dec. 15 for coverage starting Jan. 1, and people who have selected a plan but not yet paid. Secretary of Health and Human Services Kathleen Sebelius defended the move in a conference call with reporters after the release, calling it the most reliable way to measure enrollment given the six-month window before people face tax penalties for going without coverage.  

Sebelius also compared the launch of the exchanges with the experience of Massachusetts before a similar system took effect in January 2007 under the reform package that served as a model for Obama’s Affordable Care Act. Only 153 signed up in November of 2006, but by December of the following year 158,000 were enrolled. The initial figure was only .3 percent of estimated enrollees in Massachusetts, compared with 1.5 percent for the nationwide experience, according to HHS. 

“We know from experience in the Bay State that people tend to research and consider options, talk things over with their families, before making a purchase,” Sebelius said.

Robert Laszewski, a Virginia-based health care consultant who’s been highly critical of the administration’s faulty rollout, said it’s fair to count people who haven’t yet paid for coverage because many haven’t yet been billed, but Massachusetts isn’t a fair comparison. 

“They had a soft opening the first month, which is what these guys should have done,” he said. "Massachusetts technically opened but didn’t promote the site. They focused on the Medicaid population.”

After the end of the second month, Massachusetts had 2,089 people signed up. That number jumped to more than 5,000 by the end of the third month. Early leaks that were reported by the Washington Post and the Wall Street Journal put enrollment in the federal exchange’s first month at 40,000 to 50,000. That’s abysmal by any standard, Laszewski said. “To get 27,000 in 36 states means only about 25 people per state per day have been enrolled. That’s shocking.”

Others see reason for optimism. Given the near-inability for people to sign up for coverage in Healthcare.Gov’s early days, meeting 1.5 percent of the 7 million people expected to find health insurance through an exchange isn’t bad, considering the amount of time that remains before penalties take effect, said Sara Collins, vice president for health coverage and access at the Commonwealth Fund.  

“There have been considerable problems with the website, so I think in spite of everything these are positive numbers and we should see strong enrollment growth over the next six months,” she said. She pointed to surveys from the Commonwealth Fund that show people are increasingly aware of the exchanges, and a majority of those polled say they'll return despite glitches.

Sebelius reiterated that her agency expects the website to allow most people to sign-up in a single sitting by Nov. 30. 

Thirty-three percent of enrollment in the federal exchange has come from offline. That number is just 3 percent in the states that are running their own exchanges. Two of those states plus the District of Columbia didn’t report any online sign-ups. For a full breakdown, read the report here

Chris covers health care for GOVERNING. An Ohio native with an interest in education, he set out for New Orleans with Teach For America after finishing a degree at Ohio University’s E.W. Scripps School of Journalism. He later covered government and politics at the Savannah Morning News and its South Carolina paper. He most recently covered North Carolina’s 2013 legislative session for the Associated Press.
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