It’s not quite time to freak out over Obamacare’s enrollment number

November 12, 2013
(Photo by Jonathan Bachman/Reuters)
(Photo by Jonathan Bachman/Reuters)

The Wall Street Journal broke the news Monday that fewer than 50,000 people have enrolled in the new health care exchanges, a figure that we confirmed at The Washington Post.

That seems like a pretty small number of enrollees. Yet we haven't seen much public panic from health law supporters. "I think everybody anticipated the early months would have relatively low enrollment," Ron Pollack, president of the nonprofit health-care advocacy network Families USA, told me Monday night. "Obviously, with the Web site malfunctioning, that made the likely conclusion inevitable."

Some of this apparent calm could simply be the deliberate optimism of the health care law's advocates. But, putting aside any such bias, we can still make a case that the health law's debut is not a complete disaster.

First, we can compare the rollout to that of the Massachusetts health care law, which had 123 enrollees sign up during the first month of coverage. That ended up accounting for 0.3 percent of first-year enrollment. If we tally up 40,000 enrollees in the federal marketplace --and another 49,000 in the state exchanges, as counted by consulting firm Avalere Health --that works out to about 1.2 percent of the 7 million people the Congressional Budget Office has projected will sign up on the exchange in 2014.

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Massachusetts eventually saw a really big spike in enrollment right before the individual mandate kicked in. You can see that in this chart from the New England Journal of Medicine (which Adrianna McIntyre discusses in an aptly titled post, "This chart should be getting more attention.").

We can also look at Medicaid enrollment, which has outpaced some observers' expectations. There have been at least 440,000 Medicaid enrollments so far, according to Avalere. That would put Medicaid about 5 percent toward a projected enrollment of 9 million in 2014.

Is it easier to enroll people into a program such as Medicaid that does not charge premiums? Definitely. Is that program a key part of the health care law, responsible for more than half of the health law's coverage expansion? Yes. So, these high levels of Medicaid enrollment in the first few weeks do matter for the health law's insurance expansion.

Most health policy experts I talk to aren't as concerned about the number of people who sign up for the health care law as they are about who actually enrolled. Was it a wave of sick people with really high health care costs, or did that group of under 50,000 people include a good chunk of younger, healthier people who don't visit the doctor all too often?

Even that ratio will be difficult to figure out before March, when open enrollment ends. As the chart above on Massachusetts shows, a lot of healthy people might wait until right before the individual mandate kicks in to sign up for a plan. If you'd like to pencil in some time for freaking out about the health law's failure, it's probably best to schedule it for early April, when we'll have more definitive data on who is actually signing up for Obamacare.

 

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Brian Fung · November 12, 2013