Federal health officials rushed to release the report immediately before Health and Human Secretary Kathleen Sebelius is scheduled to testify Wednesday morning on Capitol Hill for the second time since the federal online marketplace debuted Oct. 1 with myriad computer defects that thwarted many of those trying to acquire insurance. Sebelius is scheduled to appear before the House Energy and Commerce Committee, whose Republican leaders have been eager to capitalize politically on the marketplace’s troubled beginning.
The report spans a period that ends Nov. 30, the deadline the White House and federal health officials had set for trying to correct many of the Web site’s flaws — a goal they say they achieved. Sebelius’s prepared testimony focuses on technical work that has improved the site’s performance — and on accelerating enrollment in recent weeks.
The report attempts to put the best face on the marketplace’s initial performance. HHS officials had said that they would issue monthly reports, but the figures printed in the new 15-page document are cumulative for the two-month period.
Federal health officials said last month that they would soon begin to include information about the age and other characteristics of the people signing up, but the report does not contain such demographics. The portrait of the newly insured is important because the price of health plans in the marketplaces will be most stable if they attract young, healthy Americans, along with people who are older, sicker and expensive to insure.
Although federal health officials emphasized that they are encouraged that the enrollments quickened after the slow first month, the figures make clear that, through November, progress was still lagging behind the administration’s expectations.
The Congressional Budget Office has forecast that 7 million Americans will have gained health coverage by spring — a goal that the administration has embraced. In a telephone call with reporters, Michael Hash, director of HHS’s Office of Health Reform, adhered to that prediction.
“We think we are on track, and we will reach the total that we thought,” he said, noting that Americans have 3 1
2 months left to sign up for coverage during a six-month open-enrollment period that runs through March.
The new marketplaces are a central element of a sprawling 2010 law intended to reshape the U.S. health-care system, including by thinning the ranks of people who are uninsured and, as a result, are less likely to receive the medical care they need.
In one of the law’s most controversial aspects, most Americans will be required to have coverage by early next year, or risk a fine. Most people with private health insurance buy it through their jobs. The marketplaces are intended for the relatively small fraction of people who would otherwise need to buy coverage on their own. It also is intended for small businesses, but that part of the program has been delayed for a year because of the system’s computer difficulties.
The report shows that about 137,000 Americans had enrolled in health plans through the federal marketplace by the end of November. Although the document does not spell out the November enrollments, a comparison of the cumulative figures with the October enrollment of nearly 27,000 indicates that about 110,000 people signed up through the federal exchange last month.
Among the 14 states that are operating their own exchanges, the number of people who chose a health plan doubled from about 79,000 in October to about 148,000 last month.
The report also makes clear that nearly 407,000 people last month — slightly more than in October — found out via the marketplaces that they qualify for Medicaid or the Children’s Health Insurance Program, public insurance for people with lower incomes. The reports did not say how many of them joined those programs, in part because a facet of the online system that is supposed to automate enrollment is not yet working.
In the Washington region, enrollment in Maryland’s troubled exchange nearly doubled, from 1,284 in October to 2,474 in November. In Virginia, which relies on the federal exchange, slightly more than 1,000 people had signed up for private insurance in the first month. In November, that number had nearly quadrupled, to 3,923. The report did not include figures for the District of Columbia, which is operating its own exchange.
Richard Sorian, a spokesman for DC Health Link, has said that, unlike the federal figures, the District’s exchange does not track individuals but that people in 1,115 households had signed up for coverage.
Nationwide, the pace of enrollment varied significantly.
Some of the state-run exchanges have experienced an increase in sign-ups in November.
In California, enrollment in private plans rose from 35,364 in October, to more than 100,000 for the two months ending in November. Similarly, in New York, more than 16,000 people had chosen private plans by the end of October, and 45,513 had signed up by the end of the two-month period.
The smallest enrollment is in Oregon, where 44 people have signed up through November. The state-run marketplace there has had serious computer problems.
Among the three dozen states relying on the federal exchange, the greatest enrollment has been in Florida, where nearly 18,000 people have signed up during the first two months.