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ObamaCare Clusterfuck: November enrollment reports

Looks like we're finally starting to get some data. Timothy Yost in Health Affairs summarizes; since the Obots will do fine picking out the positives, I'll handle the skepticism:

On December 11, 2013, the Department of Health and Human Services released its second Health Insurance Marketplace enrollment report. The report covers the period from October 1 to November 30, 2013, rather than just November, as HHS has decided to issue cumulative exchange activity reports rather than discrete monthly totals. HHS is doing this to avoid duplicate counting of the same individuals — an applicant one month may receive an eligibility determination the next and enroll in a plan the following month. Nonetheless, it also makes sense to compare activity in discrete categories from month to month, the focus of this post.

The headline is that the number of eligible individuals who selected a plan is up dramatically in November. 106,185 individuals chose a plan in October through all exchanges; 258,497 additional individuals chose plans in November, 2.4 times as many. The increase in the federal exchange was even more dramatic, from 26,794 to 110,410, an over four-fold increase. Obviously, the enrollment process has become much more navigable. ....

Other numbers are less optimistic, but probably down to the website debacle, so I'm skipping them.

The report contains information on state exchange enrollment, which yields few surprises. California’s exchange has enrolled 107,087 in marketplace plans; New York, 45,513, Washington 17,770, and Kentucky, 13,145. Oregon, on the other hand, has not yet begun processing applications electronically, and had only enrolled 44 individuals by the end of November. Among federal exchange states, Florida leads the way, having enrolled 17,908 individuals; Texas comes in second with 14,038 enrollees. In general, plan enrollment in the federal exchange states correlates roughly with population, but several states — Idaho, Maine, Montana, Utah, and Wisconsin — seem to overachieve, while New Jersey’s enrollment seems to lag.

Overall, 83 percent of completed applications were submitted online; 17 percent were on paper. HHS was unable to determine how many were submitted through direct enrollment through insurers, although the number is likely to be small. Sixty percent of applications were submitted through the federal exchange, 40 percent through state-based exchanges.

Medicaid/CHIP. Medicaid and CHIP enrollment through the exchanges continues to be strong. 803,077 individuals were assessed or determined eligible for Medicaid and CHIP during October and November; 534,103 through the state exchanges, 268,974 through the federal exchange. Moreover, this is only a fraction of the total individuals found eligible for Medicaid and CHIP during this period of time. During October alone, for example, a total of 1,460,367 individuals were determined eligible for Medicaid and CHIP by state Medicaid agencies.

Breaking down enrollment by tax credit eligibility. Two interesting trends can be observed in the report. First, the proportion of individuals determined eligible to enroll through the exchange who are also eligible for premium tax credits grew significantly during November. In October, only about 30 percent of individuals determined eligible for exchange enrollment were determined eligible for premium tax credits (34 percent in the federal exchange). In November, 50 percent were determined eligible for tax credits (42 percent in the federal exchange). Although this is still a far lower proportion than was anticipated, it would seem to indicate that more lower-income individuals are discovering the exchange and the benefits it affords. Higher-income individuals — many of whom no doubt have received nonrenewal notices from insurers in the nongroup market — continue to make up a large proportion of applicants.

Pending applications. Second, the number of pending or “other” applications continues to increase, from 201,137 in the October report to 583,473 in the October-November report. Reports of applicants facing a difficult time producing and submitting documentation to verify eligibility have become increasingly common as the exchanges attempt to ensure that individuals who receive premium tax credits are truly eligible for them. This (and website defects) seems, however, to be leaving a fair number of applicants in limbo.

With a December 15 deadline for January coverage.

What’s next? The December report does not answer perhaps the most important question about enrollment: How many Americans will the exchanges enroll for 2014?

I've heard the argument made, I think by Ezra Klein, is that the most important thing is that the pool be actuarially sound, regardless of its size. I disagree. From a public purpose perspective, and granting for the sake of the argument that health insurance means health care, getting as many people as possible covered is the most important.

Although enrollment numbers are increasing dramatically, and interest in the exchanges seems high, the number of enrollees who have selected plans through November is only a small fraction of the seven million expected for 2014. In its October report, HHS noted that in other exchange-like programs, such as the Federal Employees Health Benefits program and Medicare Part D, there is an enrollment surge near the end of the open enrollment period. With healthcare.gov reportedly now able to handle 800,000 applications a day, enrollment could easily get to 7 million by the end of March. But a lot will depend on its actual functionality, including its ability to handle direct and broker/agent enrollment, as well as on efforts to publicize the availability of the program and the success of efforts by ACA opponents to discourage enrollment.

So, now we will move from the website debacle to the crappiness of ObamaCare's policies. Undoubtedly, some will benefit, if only from the luck of the draw, and the Obama public relations effort will highlight those relentlessly. It's up to single payer advocates to use the ObamaCare rollout as a teaching opportunity, and to point out the advantages of the simple, rugged, and proven single payer alternative.

NOTE I'm not seeing any 834s numbers here. I assume that means the backend is still broken, and people who sign up know are at risk of thinking they have coverage when they don't, because Obama's tech dudes corrupted their account data.

UPDATE Yost doesn't say whether ObamaCare is likely to meet its incredibly low bar of 7 million enrolled in the first year or not. So I assume as of now, it's not likely to.

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Submitted by Dromaius on

Lack of actuarial soundness = death spiral.

If the rates soar, people will follow my and my spouse's lead and opt out. More rate soarage, more opt out. Lather, rinse, repeat. Death spiral.

So I would say actuarial soundness is at least as important because actuarial soundness MEANS coverage.

Not that health insurance has anything to do with health care, especially in the world of $3-5000/person deductibles.