State-run health insurance exchanges report November ‘enrollment surge’

November 22, 2013

After anemic enrollment in the federal health insurance marketplace, several states running their own online exchanges are reporting a rapid increase in the number of people signing up for coverage, a trend officials say is encouraging for President Obama’s health-care law.

By mid-November, the 14 state-based marketplaces reported data showing enrollment has nearly doubled from last month, jumping to about 150,000 from 79,000, according to state and federal statistics. The nonprofit Commonwealth Fund, which has been tracking the data, called the most recent numbers “a November enrollment surge.”

The latest figures from the state-run exchanges, combined with totals on the federal exchange, bring the national number to at least 176,000. While the pace of enrollments increased this month, sign-ups are still well below early projections.

On Friday, the Obama administration announced that it is giving consumers an extra week in December to sign up for coverage that begins Jan. 1, in light of troubles with federal enrollment. Insurers worried that the change would not give them enough time to process applications.

Health policy experts said the momentum from state exchanges is encouraging.

The federal health-care exchange is falling short of expectations

California, which has had about 80,000 sign-ups, is now reporting about 2,000 enrollments per day. New York and Washington state reported enrollment numbers in the tens of thousands as of this week.

A total of 27,000 enrollments were reported in October for the federal marketplace in which 36 states are relying on HealthCare.gov; the number has not been updated in November.

“It’s not all doom and gloom,” Kaiser Family Foundation President Drew Altman said. “What this says is that the problems are system problems, not problems with demand or interest.”

Health policy experts have always expected that enrollment would be slower in October because coverage doesn’t begin until January. What they did not expect was the array of technical issues that would make it difficult for even the most eager shoppers to purchase coverage.

The state exchanges that have performed well “were just better equipped and ready to handle high capacity” of users, said Sara Collins, a vice president at the Commonwealth Fund, a health policy nonprofit group. They worked out some of their technical issues, testing early on in the summer, she said.

Those states have also conducted stronger outreach, aggressively targeting young people, who generally have fewer health problems and are considered critical to the success of the exchanges.

Some of the state exchanges are seeing the pace of enrollment pick up daily. California has been out in front; the state’s enrollments have grown steadily in November and now account for nearly half 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 8,000 people enroll in private coverage.

And in Washington state, health law enrollment in private plans has jumped from 7,341 at the end of October to 11,742 through Nov. 14.

“We’re definitely seeing interest continuing to build,” exchange spokesman Michael Marchand said. “I fully suspect we may have half our enrollment coming in in December.”

Meanwhile, the federal government is giving consumers even more time, allowing them an extra week in December to sign up for coverage to begin Jan. 1. The previous Dec. 15 deadline has been pushed back to Dec. 23, said Julie Bataille, a spokeswoman for the Centers for Medicare and Medicaid Services, the federal agency overseeing HealthCare.gov. She said that the date was changed in consultation with insurers and that the administration was confident carriers would have enough time to process applications.

But industry officials raised concerns that the shortened period would not be enough time to complete the many tasks required after someone hits “submit” on an application and before a benefit card arrives in the mail.

“It makes it more challenging to process enrollments in time for coverage to begin on January 1,” said Robert Zirkelbach, a spokesman for America’s Health Insurance Plans.

Insurers are worried that a flood of new applications at the last minute, combined with the inaccurate enrollment data they are receiving from HealthCare.gov, will leave them scrambling to verify information and receive payment.

Health and Human Services officials also announced Friday that insurers in Florida, Texas and Ohio will launch a pilot program to allow consumers to directly enroll in coverage, bypassing HealthCare.gov. This type of enrollment was always supposed to be an option for consumers, but the online system has not worked properly.

The administration also confirmed Friday that it is pushing back next year’s open enrollment by one month, so that it begins Nov. 15 instead of Oct. 15 and ends in early January instead of December.

Republicans accused the administration of a blatantly political effort to shift the sign-up period until after the Nov. 4 election and delay bad news that might result from the next round of open enrollment.

But from a policy perspective, the deadline change also gives insurers an extra month to set rates for 2015. Insurance companies would have until May 2014, instead of April, to file their rates. With the current open enrollment ending March 31, insurers have long complained that it would be difficult to know, for example, how sick a particular group of people are and how to factor in that information in setting premium rates for the following year.

Also Friday, Jeffrey Zients, who was appointed by Obama in October to fix HealthCare.gov’s problems, said he was “very confident” that the federal site would be able to handle 50,000 simultaneous users by the end of this month. “The site was originally intended to handle this load, and improvements will bring it up to this level,” Zients said. “We will have the capacity that was intended.”

Lena H. Sun is a national reporter for The Washington Post, focusing on health.
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