State-based health in­sur­ance mar­kets en­roll 3 per­cent so far

Slow start ex­pected to speed up in time

The Washington Times Daily - - Politics - BY TOM HOWELL JR.

Just 3 per­cent of those ex­pected to even­tu­ally sign up for Oba­macare’s state-based health mar­kets in a dozen states run­ning their own mar­kets have ac­tu­ally signed up so far, ac­cord­ing to an anal­y­sis Mon­day from a health con­sul­tancy that pre­dicted the pace will even­tu­ally pick up.

Avalere Health said that by the end of next year, the 12 states are ex­pected to have 1.4 mil­lion en­rollees in their health ex­changes. As of Sun­day, though, 49,100 had ac­tu­ally signed up.

“I would ex­pect to see these num­bers to grow over time. This hap­pens grad­u­ally,” Avalere CEO Dan Men­del­son said in an in­ter­view, cit­ing the slow start to the Medi­care drug ben­e­fit pro­gram dur­ing the Ge­orge W. Bush ad­min­is­tra­tion.

The Con­gres­sional Bud­get Of­fice projects that 7 mil­lion peo­ple would en­roll in the health ex­changes set up un­der the Af­ford­able Care Act. Some states elected to set up their own ex­changes, but most left the job to the fed­eral govern­ment, whose web­site is sup­posed to help en­roll po­ten­tial cus­tomers but has been plagued by prob­lems since its Oct. 1 launch.

Some states, mean­while, have re­ported their own web­site prob­lems.

Be­tween the fed­eral prob­lems and is­sues in var­i­ous state-run mar­kets, there is a “cli­mate of scru­tiny and neg­a­tiv­ity” that may have sup­pressed en­roll­ment among the states in Avalere’s anal­y­sis, Mr. Men­del­son said.

For weeks, the Obama ad­min­is­tra­tion has pre­dicted that en­roll­ment would start slowly and pick up speed by early De­cem­ber, when en­rollees race to buy plans in time to gain cov­er­age by Jan. 1. But if slow-en­roll­ment trends con­tinue be­cause of Web glitches or a lack of in­ter­est in the ex­changes, it could spell trou­ble for the over­haul.

The D.C. ex­change, which is run by the city govern­ment in the na­tion’s cap­i­tal, signed up only 1 per­cent, or 300 en­rollees out of a pro­jected 25,000, ac­cord­ing to the anal­y­sis. It was the low­est per­cent­age among the 12 ex­changes stud­ied by Avalere.

How­ever, a spokesman for the D.C. ex­change said Fri­day they’ve been “very pleased with the strong, en­thu­si­as­tic re­sponse from the res­i­dents and small busi­ness own­ers in the Dis­trict.”

As of Oct. 21, 12,294 city res­i­dents had cre­ated per­sonal ac­counts at D.C. Health Link and 321 of them had se­lected a health plan for en­roll­ment, he said. Since those ac­counts may in­clude cou­ples and fam­i­lies, the to­tal num­ber of newly cov­ered in­di­vid­u­als is likely higher than 321.

Ken­tucky, the only state-run ex­change in the South, has en­rolled 4,600 peo­ple out of a pro­jected 73,000, or 6 per­cent, while Wash­ing­ton State boasted 7,300 en­rollees, or nearly 7 per­cent of its 110,000 pro­jected par­tic­i­pants, ac­cord­ing to Avalere.

Ver­mont ex­pects to en­roll 30,000 peo­ple on its state-run health ex­change. So far, it has en­rolled 3,500, or 12 per­cent, of its pro­jected par­tic­i­pants.

Avalere’s fig­ures found that in­ter­est in the D.C ex­change lags be­hind states. Just 15,000 peo­ple have vis­ited D.C.’s on­line ex­change por­tal, or 60 per­cent of the fi­nal to­tal en­roll­ment tar­get. Most other states saw much higher lev­els of in­ter­est.

States like Wash­ing­ton and Colorado, mean­while, are see­ing three to four times as many unique visi­tors to their Web por­tals as pro­jected en­rollees.

Mr. Men­del­son, how­ever, said he does “put a lot of stock” in the unique visi­tors num­bers — they could be de­fined in var­i­ous ways and were drawn from press re­leases, in­ter­view and news ar­ti­cles — and their im­pli­ca­tions for even­tual en­roll­ment to­tals.

He also said the en­roll­ment pro­jec­tions are fluid fig­ures that should be viewed with two caveats in mind.

Avalere’s pro­jec­tions re­flect those who are ex­pected to en­roll through an ex­change, but it is pos­si­ble that some res­i­dents will opt to pay a tax penalty for fail­ing to gain in­sur­ance — a sanc­tion that kicks in dur­ing tax fil­ing sea­son in early 2015 be­cause of the law’s in­di­vid­ual man­date.

In that case, the firm’s pro­jected en­roll­ment would fall, Mr. Men­del­son said.

Con­versely, some of the states listed in the study may adopt the so-called Arkansas model for ex­pand­ing Med­i­caid to those mak­ing up to 138 per­cent of the fed­eral poverty level. Un­der this method, the state uses an in­flux of fed­eral funds for the en­ti­tle­ment pro­gram to pur­chase pri­vate in­sur­ance for the newly el­i­gi­ble pop­u­la­tion, a move that would boost en­roll­ment num­bers on the cor­re­spond­ing state ex­changes.

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