The White House and its supporters have begun bragging that the ObamaCare system has started to function as planned, with sign-ups increasing as the deadlines approach for the individual mandate deadline. But how many of those sign-ups turned into actual enrollments through the payment of the premium? As it turns out, not nearly as many as the top-line numbers suggest:
While the number of states reporting this information is small, they actually make up a good chunk of Obamacare’s currently accepted 3 million nationwide enrollment total. According to the Obama administration’s most recent detailed report on enrollment data, these five states — New York, California, Washington state, Nevada and Rhode Island — account for a third.
California’s exchange last reported that three-fourths of its reported enrollees had paid their first premiums, according to California Healthline; Washington’s totals released Tuesday indicate that only 51 percent have purchased their plans.
New York’s numbers are fuzzier, since the exchange itself doesn’t separate applications for Medicaid and private plans. It counts 412,221 enrollments for public and private coverage (just 251,000 are private plans), but notes that another 697,000 customers have completed applications on the exchange website. If the entire 421,221 have paid (or accepted the low- to no-cost Medicaid coverage), New York’s payment rate is only 59 percent.
Those numbers aren’t much improved from a month ago, when industry expert Bob Laszewski estimated the payment figure at 50%. The federal system’s back end for dealing with those issues is still missing in action, too, which means it’s going to be even more problematic. We’re about a month out from the big deadline for the April 1 cutoff for enforcement, and at the very best, we can say that the signup-to-paid ratio isn’t improving by much, if at all.
That may be a surprise to Laszewski, who predicted an 80% clearance rate by this time, which only Rhode Island appears to be achieving. He also noted a multitude of issues in the federal system still awaiting resolution:
Last fall I said that I thought it would be late January or early February before Healthcare.gov would generally be fixed.
Boy, was I wrong.
The to-do list still includes:
- Problems with the government sending enrollment transactions to the carriers––the 834s––that are still having error rates much too high for high volume processing.
- The inability of the government to do an automated enrollment reconciliation with the carriers––to be able to sort out who really is covered and who is not––because that system still hasn’t been built.
- The inability of the government to pay carriers because that system hasn’t been built––carriers are sending estimated bills to the feds.
- The inability of the government to add and delete people from the system for things like a newborn or a divorce because that system hasn’t been built yet.
- The inability of the government to handle appeals when people think their eligibility or subsidy calculation is wrong because that system hasn’t been built yet.
- The inability of the government to cancel people off of Healthcare.gov because they never built that functionality. As a result, I expect they will be reporting bloated enrollment numbers for some time.
At least two carriers have told me that because the government can’t cancel people off the system, it the person shows up next month they can’t reenroll on Healthcare.gov because the government can’t get the old enrollment off the system.
What kind of progress is being made in Minnesota, where the MNSure administrator ended up getting fired over its launch failures? Investors Business Daily offers a look, and it’s not pretty:
Minnesota’s exchange enrollment goal of 67,000 seemed within reach on Jan. 4, when signups stood at 25,860.
But after surging by more than 4,000 per week in the prior five weeks, signups collapsed back to November’s pace of less than 700 per week. …
Only 21% of signups were in the key 18-34 demographic vs. 35% ages 55 to 64. Minnesota officials have been taken by surprise at the share of people signing up for ObamaCare’s richest “platinum” coverage, which reimburses 90% of the covered group’s qualifying expenses.
Fully 29% have signed up for low-deductible platinum policies — compared to a projection of 5%. Such policies would tend to be favored by people who want to guard against high medical expenses, while someone expecting minimal costs might go for a high-deductible bronze plan.
In fact, the shortfall of sign-ups — let alone actual enrollments — threatens to create a budget crisis:
Enrollment is currently at 92,000, which is still way short of their goals by for enrollment prior to March 31. The worry is if they don’t have enough people paying into MNsure, it won’t be sustainable and they’ll have to ask the legislature for more money.
Minnesota lawmakers have warned leaders of MNsure that they must figure out budget needs soon as insurance enrollment trends point to a 2015 deficit. MNsure must give lawmakers a proposed 2015 budget by March 15.
The 92,000 figure includes the Medicaid enrollments through the system, too. The problem is in the lack of private-insurance enrollments, and it’s going to be a huge problem for the state legislature, which is already strapped for funds as it is.
Guy Benson hits the numbers:
This portends two separate risk pool problems. First, not enough young and healthy people are signing up — a trend that has been well established for some time. Minnesota’s 21 percent figure is nearly identical to what health insurer Humana is reporting in its nationwide risk pool so far — and roughly half of the administration’s initial goal within this demographic. Second, a surprisingly high number of enrollees are selecting “platinum” plans, indicating that they anticipate incurring high levels of annual medical expenses and are looking to minimize out-of-pocket costs. Add these two together, and you’re staring at an adverse selection problem, which may result in larger taxpayer bailouts of on-the-hook insurers.
Also take note of the paltry payment rate of “enrollees” in Washington State so far … Washington has a payment rate of just 50 percent, with Nevada sitting at 66 percent. Both states are far off pace to hit their 2014 targets, even counting unpaid “enrollments.”
Be sure to read it all.