The Conversation

Enrollment is Still Way Behind Schedule (Updated)

The message being echoed today by progressive supporters of the President's health plan is that things are looking up. But the message is more hype than it is reality at this point.

Tuesday morning both Slate and Wonkblog excerpted a piece by LA Times Health reporter Noam Levey. Here's the relevant portion:

A number of states that use their own systems, including California, are on track to hit enrollment targets for 2014 because of a sharp increase in November, according to state officials.

"What we are seeing is incredible momentum," said Peter Lee, director of Covered California, the nation's largest state insurance marketplace, which accounted for a third of all enrollments nationally in October. California — which enrolled about 31,000 people in health plans last month — nearly doubled that in the first two weeks of this month.

Several other states, including Connecticut and Kentucky, are outpacing their enrollment estimates, even as states that depend on the federal website lag far behind. In Minnesota, enrollment in the second half of October ran at triple the rate of the first half, officials said. Washington state is also on track to easily exceed its October enrollment figure, officials said.

According to Levey, California is "on track to hit enrollment targets." That's not true, not unless California has revised it's targets substantially. Back in September, Peter Lee of Covered California announced the state's enrollment goals. They were "to have 500,000 to 700,000 subsidy-eligible Californians enrolled in the exchange by April 1." Lee added that "Our goal is to blow the roof off all of these estimates."

Right now that is not happening. Forget about blowing the roof off, California probably won't reach the lowest estimate. Depending on how you parse Lee's statement, they may not even be close. According to the NY Times last week, "Of about 31,000 people who signed up for private plans in October, only about 4,850, or 16 percent, qualified for subsidies to help with premium costs." So the number of subsidy eligible enrollments was 1 percent of the goal in October.

Payers and Providers, a subscription based news service dedicated to health care, looked at California's enrollment numbers up through the first half of November and estimated they were on track to enroll 289,000 by April 30, 2014. Obviously that's well short of the 500k projection and it's not even clear if the 289k are all subsidy eligible as Covered California's Peter Lee specified. Bottom line, California is not on track to meet its goal. Of course that could change but right now it's not looking so good.

The LA Times story also mentions Connecticut, Kentucky and Minnesota. Connecticut's goal was to enroll 100,000 people by the close of enrollment next year. So far they have managed a total of 12,648. If the rate of enrollment doubles in the next six weeks and then doubles again after the new year they could reach the goal but they're still a long way off now with no guarantees.

Kentucky has been a bright spot for supporters of the law but it has only enrolled about 8,780 in qualified health plans so far out of an estimated 332,000 uninsured who are not eligible for Medicaid. I'm unable to locate a published document giving monthly enrollment goals set by Kentucky so it's not clear how the LA Times can claim they are "outpacing their enrollment estimates."

Finally, the LA Times is correct that Minnesota's enrollment rate tripled after the first week of October but that was largely because the system did not work for most of the first week. The bottom line result was a rather dismal 1,744 people who bought insurance on the MN exchange in October. The remainder of the 10,940 total signed up for Medicaid.

The LA Times published a piece which is as much hype as substance. Even the states doing the best seem likely to fall well short of their goals. And none of this looks at the other looming problem: the fact that enrollees are older than anticipated.

Update: As noted above, the LA Times claims Kentucky is "outpacing" its "enrollment estimates." I spoke to the chief spokesperson of the Kentucky Cabinet for Health and Family Services and pointed her toward the LA Times story. I asked her to send me the estimates in question so I could verify they had been outpaced as the Times claimed. She wrote in reply "We did not have an estimate, but we have been extremely pleased with the response we have received so far." I also did a search and found no public estimates for enrollment made by the state of Kentucky. It's not clear how Kentucky can outpace estimates that don't exist.


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