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The Agenda

NRO’s domestic-policy blog, by Reihan Salam.

The HHS Enrollment Numbers



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Charles Ornstein of Pro Publica notes that while the U.S. Department of Health and Human Services is trumpeting the news that 365,000 have enrolled in the exchanges, coverage will only take effect if enrollees make their first payments on time. And so far, it’s not looking as though many enrollees will do so:

“There is also a lot of worrying going on over people making payments,” industry consultant Robert Laszewski wrote in an email. “One client reports only 15% have paid so far. It is still too early to know for sure what this means but we should expect some enrollment slippage come the payment due date.”

Another consultant Kip Piper, agreed. “So far I’m hearing from health plans that around 5% and 10% of consumers who have made it through the data transfer gauntlet have paid first month’s premium and therefore truly enrolled,” he wrote me.

“It naturally varies by insurer and will hopefully increase as we get close to end of December and documents flow in the mail,” added Piper, a former official at the Centers for Medicare and Medicaid Services. “But overall I’m hearing it’s a small portion so far.  And that, of course, is a fraction of an already comparatively small number of people who have made it through setting up an account, getting verified, subsidy eligibility determined, plan selected, complete and correct data transferred to the insurer, and insurer set out the confirmation with invoice for consumer’s share of the first month’s premium.”

Seth Chandler raises a number of other points about the HHS enrollment numbers. Michael Hash, director of the office of health reform within HHS, insists that the exchanges will meet their enrollment target by the end of March, the deadline for avoiding the mandate penalty. Chandler argues that this target will be all but impossible to reach. Drawing on HHS’s data concerning the increase in enrollment from week to week, he extrapolates two curves for future enrollment growth — one which assumes quadratic growth and one which assumes cubic growth — and he finds that enrollment wouldn’t hit the target under either scenario by the end of March. He also adds the following:

Finally, nowhere in the release do I see an age distribution of those enrolling. Unquestionably, the administration has this information. It is required in the enrollment process. And, perhaps this is a bit cynical, but I have to think that if those numbers looked good, if the hoped-for proportion of younger persons were enrolling, the Obama administration would release the information.  I believe we are entitled to draw a negative inference from the fact that the information was not released that the pool is disproportionately elderly. If this is correct, what we are seeing is a small pool composed disproportionately of the elderly. That does not augur well for those who want to see the promises of the Affordable Care Act fulfilled.

Keep in mind that Chandler’s assessment of exchange enrollment does not factor in Ornstein’s notion that payment might not be forthcoming from many of those who have signed up.

I am curious to see how the White House will tailor its communication strategy if Obamacare implementation continues to disappoint. While some vulnerable congressional Democrats have distanced themselves from discrete aspects of Obamacare in a bid for survival, we have yet to see big moves from leading Democrats, including aspiring presidential nominees. One wonders if Massachusetts Sen. Elizabeth Warren will at some point sponsor Medicare-for-all legislation, or if some lesser-known Democrat will do the same and catapult to prominence as a result,



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