Don’t look now, but Obamacare might just hit a sign-up projection

January 24

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.

Three million people have signed up for private insurance coverage through the health law marketplaces, according to Health and Human Services. That still leaves the Obama administration lagging behind its initial projections for overall health law enrollment--but also closer to hitting monthly sign-up expectations it set back in September.

Health and Human Services says that at least 800,000 people signed up for coverage through this week. So this new figure shouldn't be seen as representing overall January enrollment--that number will likely inch up a bit, when the Obama administration releases a monthly enrollment report in February. Back in September, the Obama administration had projected 1.1 million people would sign-up in the first month of 2014--and these new figures suggest that enrollment could easily hit that number.

Since the federal government implemented significant fixes to HealthCare.gov on Dec. 1, monthly enrollment totals have inched significantly closer to the targets. Instead of netting a quarter or third of the expected sign-ups, as the administration did in October and November, now the numbers are coming in much more in range of expectations.

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That, at least, is one way to look at the data. Another is to look at cumulative health law enrollment, where the Obama administration does continue to fall behind projections, largely due to the dismal sign-up numbers last fall. Health and Human Services had expected that 4.3 million people would have signed up by the end of January. So the administration is running about 1.3 milli0n behind that projection, although with one week left in the month some of that gap is likely to close.

Generally, health policy experts had expected that enrollment in December would be a bit slower than January sign-ups. That's because December was a month with a key deadline: Shoppers had to pick a plan by Dec. 23 in order to be covered in January, the start of the insurance expansion. For those who were transitioning into the exchanges from the individual market and didn't want  a gap in coverage - or those with costly pre-existing conditions anxious to gain coverage - there was a lot of reason to get signed up at the first moment possible.

Now that pressure has lifted a bit, and shoppers have through the end of March to purchase a policy. There's no big deadline this month or in February, which means shoppers might be a bit more lax as they browse through their options. Come March though, there's likely to be another increase in enrollment as last-minute shoppers face a decision between buying coverage then, or waiting until the next open enrollment period for coverage that starts in January 2015.

One other lingering question in these enrollment figures is what percent of those who picked a plan have actually paid a premium. We don't have a figure on that from the federal government because it's the private insurance companies, rather than the government, that typically collect these payments. We do have a few clues: major health insurer Aetna says that over 70 percent of those signed up had paid for policies as of mid-January. In Washington State, one of the few exchanges that does collect premium payments, slightly fewer than half of shoppers who selected a plan have sent a premium payment to that insurer (67,200 paid customers versus 72,636 still awaiting payment, to be exact.) Subscribers aren't counted as enrolled in health insurance, from the plan's view, until they make that first plan payment.

KLIFF NOTES: Top health policy reads from around the Web.

A new worry is scaring shoppers away from Medicaid. "Add this to the scary but improbable things people are hearing could happen because of the new federal health-care law: After you die, the state could come after your house. The concern arises from a long-standing but little-known aspect of Medicaid, the state-federal program that provides health coverage to millions of low-income Americans. In certain cases, a state can recoup its medical costs by putting a claim on a deceased person’s assets." Sandhya Somashekhar in the Washington Post. 

Insurers struggle to keep up with consumers' complaints. "Both Horizon and Independence say the backlog is improving, and is rooted in the federal government's decision to shorten the enrollment deadline for people to sign up for plans to Jan. 1. Horizon enrolled 56 percent of its new members between Dec. 15 and 24. "We extended service hours, tripled our customer service staffing, and delayed the payment-due date for the first month's premium until last Friday," said Thomas Vincz, a Horizon spokesman. From Dec. 10 to 24, Independence took in 80 percent of its new members." Robert Calandra and Stacey Burling in the Philadelphia Inquirer.

A federal court rules in favor of Obamacare helpers. "A federal court has temporarily blocked Missouri officials from restricting organizations in the state from helping people sign up for health insurance as part of the federal health-overhaul law. The U.S. District Court for the Western District of Missouri granted an injunction Thursday blocking the Missouri insurance department from enforcing a state law passed last year that limited the activities of people seeking to enroll the uninsured through new insurance exchanges." Louise Radnofsky in the Wall Street Journal. 

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