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How Low Will Health Care Enrollments Be? Here’s What to Watch For

How Low Will Health Care Enrollments Be? Here’s What to Watch For

This week, the U.S. Department of Health and Human Services is expected to announce the long-awaited enrollment numbers for the first month of the health insurance marketplaces. And from all reports, they’re going to be low.

The Wall Street Journal reported Monday that the 36 states that rely onHealthcare.gov for their insurance marketplaces signed up fewer than 50,000 people in their first month of operation.

“Another way to look at the Healthcare.gov enrollments is that 50,000 enrollments over 36 states over 31 days is less than 50 enrollments per day per state,” health-care consultant Robert Laszewski wrote in an email to reporters.

The Washington Post reported this morning that the number is actually around 40,000.

That appears to be far lower than the administration’s early estimate that 500,000 people would sign up for coverage in October, the first month the marketplaces were open.

Other recent stories offer variations on that theme. Oregon has not signed up any people in its exchange. Delaware has only four. And Washington, D.C., has five.There are surely more applications in the pipeline, but these early numbers are anemic.

So how big a failure is this?

To those convinced the law will fail, it’s a disaster. The glitches that have plagued Healthcare.gov have not been solved, and the clock is ticking toward Dec. 15, the last day that consumers can sign up for insurance plans that begin on Jan. 1.

If the problems continue and only the most motivated – i.e., the sickest and oldest – sign up for coverage, insurers will be hit with big losses and will have to dramatically increase rates for 2015, the beginning of a death spiral, the critics reason.

To those convinced the law ultimately will succeed, the number means little. The problems with the website have masked demand. And the experience ofMassachusetts and Medicare’s Part D prescription drug benefit demonstrate that the vast majority of people sign up closer to the deadline. In this case, the final deadline is March 31, the day the 2014 open enrollment season closes.

Four things to look out for when the numbers are announced:

Consider those being dropped by their insurers, not just those signing up.

The Congressional Budget Office has set the bar in terms of predictions —estimating that 7 million people will sign up for coverage on the exchanges in 2014 (6 million with subsidies; 1 million without). But the CBO also seems to estimate that the number of people in the “nongroup” market, which includes individual policies, will decrease by a net of 2 million next year. It’s clear now that many more people than that are being dropped by their insurance companies, which are citing provisions of the Affordable Care Act.

 

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