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, and read previous columns here.
We're nearly one week into Obamacare's open enrollment period. What we do know: It's been a bumpy ride. What we don't know: How many people have signed up.
The White House will not be releasing data on enrollment in the federal marketplace until November, CNN's Jake Tapper reports. We do have some data trickling out from the states right now though -- but even with those initial numbers, deciding who counts as an Obamacare enrollee can be tricky business.
That's because there are a number of steps in the application process for health insurance under the Affordable Care Act. And states are using lots of different metrics to determine how well their new insurance marketplaces are going.
When the District of Columbia's Health Benefit Link crunches the numbers on who has done what on their Web site, they put people into four different categories depending on how far they've gotten in the process. First are people who have created an account online and are browsing the Web site. Aaron Strauss, who has taken on the task of counting up these registrations, estimates that 175,000 people have created accounts on the state-based marketplaces over the past week.
Second are the people who have filled out the application for insurance but haven't actually committed to the policy. This is like when you're shopping on Amazon, have dropped an item in your shopping cart but haven't clicked to checkout yet. You're almost there but not totally done.
Then there are the people who have selected a plan and moved on to checkout - but haven't enrolled quite yet, instead requesting an invoice. Who wants to pay a premium in October, after all, for a policy that doesn't start until January? On the D.C. Health Link's first day, 175 people requested invoices whereas four people actually went ahead and paid the premium.
Across the country, states are muddling together their own definitions of what counts as enrollment. In Kentucky, where 11,879 people are enrolled in coverage, all of them have paid the first month's premium for their policy. In Rhode Island, an enrolled individual is "an individual who has supplied all of the necessary information, had that information verified, and has selected a plan. Payment was either made or is pending," per spokeswoman Dara Chadwick.
Maryland is tracking two separate metrics: Enrollment in plans and applications submitted with a verified identity. Both have increased, as you can see in Maryland's graphs below, although applications still remain higher than enrollment.
Going forward, it's worth keeping in mind that all these numbers will be swirling around as we talk about Obamacare enrollment. Some, like applications created or submitted, will seem higher. Others -- namely, people who have enrolled in a plan and paid a premium -- will likely be lower. All of them tell us a bit about how Obamacare enrollment is going, but none will be a complete picture of the number of people likely to receive coverage through the new health law.
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We're not getting federal enrollment data until November. "The Obama administration is not planning on releasing enrollment numbers on Obamacare until November, senior administration officials said Monday, as they continued to insist that delays with the healthcare.gov website were entirely the result of high volume. 'We will release monthly data when it is available,' a senior administration official told CNN. 'We have not given an exact date, but it will be after end of month and we will work with states to collect their data to have a good picture of what's happening across the country.'" Jake Tapper for CNN.
Coding issues are creating trouble for HealthCare.Gov. "The website is troubled by coding problems and flaws in the architecture of the system, according to insurance-industry advisers, technical experts and people close to the development of the marketplace. Among the technical problems thwarting consumers, according to some of those people, is the system to confirm the identities of enrollees. Troubles in the system are causing crashes as users try to create accounts, the first step before they can apply for coverage." Christopher Weaver, Shira Ovide and Louise Radnofsky in The Wall Street Journal.