Welcome to Health Reform Watch, Sarah Kliff’s regular look at how the Affordable Care Act is changing the American health-care system — and being changed by it. You can reach Sarah with questions, comments and suggestions here. Check back every Monday, Wednesday and Friday afternoon for the latest edition or sign up here to receive it straight from your inbox. Read previous columns here.
Health Reform Watch's Fix Tracker!
President Obama has asked states to allow insurance companies to renew non-Obamacare compliant plans through 2014. We'll be using this tracker to keep a running list of how states are deciding. For a more thorough version of this tracker, check here. And let us know if your state is missing!
Allowing late renewals: Hawaii, Ohio, N.C., Fla., Ky., Tex.
Not allowing late renewals: Calif., Mass., Md., Minn., R.I., Vt., Wash.
Still deciding: Colo., D.C., Ind., Miss., Ore., S.D.
By the end of October, the federal government had counted 106,000 people enrolled into private coverage through the new health insurance marketplaces, a small percentage of the projected half-million sign-ups.
By mid-November, though, with the 14 state-based marketplaces reporting fresh data, that number had just about doubled to more than 200,000.
Health policy researchers are starting to describe something that they call a "November surge": After anemic enrollment in October, states have seen a much faster pace of sign-ups in November.
"The latest enrollment figures from the 14 states that are running their own marketplaces show that enrollment has climbed to at least 200,000 people nationwide," Sara Collins and Tracy Gruber write today for the Commonwealth Fund. "This latest figure does not account for any new enrollment in the federal marketplaces in 36 states, which is also likely to have increased since early November."
State officials say they are seeing an uptick in sign-ups this month. California, which has had about 80,000 sign-ups, is now reporting about 2,000 enrollments per day. New York and Washington reported double-digit enrollment numbers as of this week.
"It's not all doom and gloom," Kaiser Family Foundation President Drew Altman says. "What this says is that the problems are system problems, not problems with demand or interest. Reason would suggest that other states can do as well over time, if we're able to do this in Kentucky or Washington."
Health policy experts have always expected that enrollment would be slower in October than it would be in November or December, given that no coverage even starts until January. What they did not expect was a whole host of technical issues that would make it difficult for even the most eager of shoppers to purchase coverage. The White House contends that this depressed enrollment in October, at least in the federal marketplace.
That hasn't been true everywhere: Some state-based marketplaces had a pretty smooth launch, and are seeing the pace of enrollment speed up daily.
California has lead the bunch; the state's enrollments have grown steadily in November and now account for nearly a full third of all health law sign-ups. The state has had its strongest two weeks of enrollment this month.
"We're seeing much larger numbers than we expected," Covered California Executive Director Peter Lee told reporters this week.
Connecticut officials say they have seen about 14 percent of their expected enrollees sign up through mid-November. The state has had about 14,000 people sign up for coverage so far, about 58 percent of whom have purchased private coverage and 42 percent of whom have enrolled in the public Medicaid program.
And in Washington, health law enrollment has nearly doubled, from 55,000 at the end of October to 98,000 through Nov. 14.
"We're definitely seeing interest continuing to build," Washington exchange spokesman Michael Marchand said. "I fully suspect we may have half our enrollment coming in in December. Especially for those who are buying private plans where payment isn't due until December, some of them are sitting back and waiting to take action."
Other states are expecting a similar, post-Thanksgiving wave.
"We’re going to see a surge, after Thanksgiving and mid-December, and I think that mix is going to favor more folks” picking private plans than Medicaid, said Kevin Counihan, executive director of Access Health CT.
A handful of functional state marketplaces don't fix all the problems that states are having with the federal marketplace. Instead, Kaiser Family Foundation's Altman sees the snowballing enrollment numbers as a proof of concept.
"We're in a period of a terrible roll-out," Altman said, "but the performance of the pace-setting states should be a cause of optimism for supporters."
KLIFF NOTES: Top health policy reads from around the Web.
Filibuster reform will make it easier to appoint IPAB members. "The Senate's rules change will likely make it much easier for President Obama to fill the Independent Payment Advisory Board, or IPAB — a 15-member panel tasked with slowing the growth in Medicare spending. The IPAB is a polarizing piece of the Affordable Care Act: It's been a feature of GOP campaign ads, and the House has voted to repeal it. The IPAB is technically supposed to submit its first proposed cuts in January, but Obama hasn't even nominated anyone to the board yet. Nominees have to be confirmed by the Senate, which until today required 60 votes — and Republicans were highly unlikely to help confirm anyone to the board." Sam Baker in National Journal.
Insurers will get an extra month to set 2015 rates. "The enrollment period, previously scheduled to begin Oct. 15, 2014, will now start Nov. 15, said an official with the U.S. Department of Health and Human Services who asked not to be identified because the decision isn’t public. Technology failings in the new government-run insurance exchanges are undermining efforts to attract the broad array of customers needed to keep plans affordable in the long run. Avoiding a large increase in prices next year is “absolutely critical” if Obama wants to preserve his signature legislative achievement, said Ana Gupte, a Leerink Swann & Co. analyst. Alex Wayne in Bloomberg News.
Wall Street analysts see Nov. 30 as a crucial health law date. "Wall Street health care analysts warned Thursday that a failure to successfully launch HealthCare.gov by Nov. 30 could send Democrats fleeing from Obamacare and industry stocks into turmoil. “If the website is not functioning on Nov. 30, then I think you see a stampede of Democratic legislators in risky elections next year,” said Carl McDonald, a senior analyst at Citi Investment Research, at a conference organized by the Center for Studying Health System Change." Kyle Cheney in Politico.