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Enrollment in the Health Insurance Marketplace totals over 8 million people
More than 4.8 million additional Medicaid/CHIP enrollments
Enrollment in the Health Insurance Marketplace surged to eight million at the end of the first enrollment period, HHS Secretary Kathleen Sebelius announced today. The final enrollment reporting period spans from October 1, 2013, to March 31, 2014, and includes “in line” and other enrollment activity (such as people enrolling due to a change in life circumstance) reported through Saturday, April 19, 2014.
“The Medicaid numbers are great,” said Richard Onizuka, CEO of the exchange, in an interview with TVW on Wednesday. “The private health insurance — the qualified health plans — are really robust. We didn’t know what to expect, but to have 125,000 as of Monday is a pretty good number for us.”
Unfortunately, it’s still short of the state’s goal and what enrollment was projected to be at this point.
“Questions need to be asked about the long-term sustainability of the Washington exchange if they don’t hit their target of 150,000 individuals this year,” said Josh Archambault, senior fellow at the Foundation for Government Accountability, a Naples, Fla.-based think tank. “The federal government has required them to be self-sustaining in a couple of years, and if they’re not, all taxpayers in the state might be asked to bail out the exchange.”
Archambault also noted the state’s numbers are deceptive because, although 125,000 Washingtonians have signed up to purchase private health insurance, fewer than half have actually paid for it — even with federal subsidies.
“So we could really be talking about closer to 62,000 signing up if the current payment rate stands,” he said, “not 125,000.”
Washington’s 47 percent payment rate is among the lowest in the nation, Archambault said.
“That’s a real concern for the taxpayers,” he said, “because the exchange is expected to be self-sustaining. If it’s not, your Legislature is going to have to have a difficult conversation about whether it wants to make up the difference out of the general fund or taxing small businesses or something like that.”
But it gets worse. While the state will receive a temporary federal subsidy to help pay for the additional Medicaid recipients, it isn’t getting any help with the extra administrative costs associated with the sign-up effort.
Is the Administration Low-Balling Their 2015 Obamacare Enrollment Estimate?
Well, with an estimate of only 9 million to 9.9 million, apparently they are. But I will suggest the focus should not be on anybody's estimate for 2015 but rather on how many people need to enroll in Obamacare to make it sustainable.
A few points:
The Kaiser Family Foundation estimated that when Obamacare launched in 2014, 17.2 million people were eligible for subsidies.
The only place you can get an Obamacare subsidy is in the state and federal health insurance exchanges.
The longtime insurance industry underwriting rule is that you need 75% of an eligible group to be confident of a sustainable risk pool––that is enough healthy people paying in to offset the cost of the sick people.
So far 85% of those who have purchased health insurance in the exchanges are receiving a subsidy.
The insurance company "3Rs" reinsurance program, that protects the carriers from most Obamacare underwriting losses, expires at the end of 2016.
So, Obamacare needs to have a sustainable population participating by the time the insurance company support expires at the end of 2016.
While many more people will enroll off-exchange, the number of the subsidy eligible population enrolling is an easy number to get and, I will suggest, serves as a pretty good proxy for Obamacare's success.
It's a fairly easy calculation to figure out how many people we need in the Obamacare exchanges to be confident the program will be self-sustaining.
First, we need 75% of those 17.2 million who were subsidy eligible in the first place, or 12.9 million.
Presuming that 85% of those in the exchanges continue to be on subsidy, we would need a total of 15.2 million (12.9 million getting a subsidy and another 2.3 million not on subsidy) in order to reach a sustainable level.
Now, the 75% threshold is a guideline. Maybe the right number the exchanges need to hit is 14 million, or maybe it is 16 million. But this is the ballpark we need to be in.
The Congressional Budget Office (CBO) has estimated that 13 million will buy health insurance in the Obamacare exchanges by the end of 2015. To stay on a sustainable enrollment track, that 13 million estimate makes sense to me––leaving a net gain of only another 2 million in the third and final year of open enrollment.
Today, the administration said that their goal is for 9 million to 9.9 million to be purchasing health insurance on the exchanges by the end of 2015.
Is that a low-ball estimate designed to manage expectations?
Apparently. But playing expectation games is not what they need to be successful at.
Enrolling enough people for a sustainable insurance pool by the end of 2016 is what they will need.
If Obamacare isn't up to a sustainable enrollment level by the time the health insurance company reinsurance protections expire at the end of 2016, the 2017 rate increases will be huge.
Those 2016 rate increases will be released on about Election Day 2016.
Low-balling expectations might buy you some short-term media puff.
But if they don't get this thing to a sustainable enrollment level by November of 2016 no one will remember their latest PR campaign.
originally posted by: ketsuko
Given that you might not have a state run exchange and if you don't, you might not be legally eligible for subsidies ... that analysis might be overly rosy.
originally posted by: OrphanApology
a reply to: Granite
What they are failing to mention is that not only do they need more people for it to work out, they need young people. Incidentally that's a group that is either A. Going to get Medicaid or B. Won't get this #ty overpriced insurance and will just take hit because they never get sick anyway.
How many 20-30 year olds do you know that have an ACA plan?
I really wish the ACA, aka Nixon's Managed Health Care Scam Version 2.0 would just go away.
Importantly, 2.2 million (28 percent) of those who selected a Marketplace plan were young adults ages 18 to 34 — a number that grows to 2.7 million when counting ages 0 to 34, the report found. The report also shows, for the first time, the race and ethnicity of the 69 percent of enrollees in the Federally-facilitated Marketplaces who voluntarily reported this information.