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.

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Thirty-five days into the health law's open enrollment period (who is counting?), it's fair to say we know two things about Obamacare's potential shoppers.

First, there are lots of them: HealthCare.gov has produced really big traffic numbers in its first month. And about 700,000 people created applications on the Web site, which is at least something of an indication of doing more than checking if the Web site is working.

Second, there are not a lot of enrollees: Documents from inside the agency implementing the health law from Oct. 3 showed exactly 248 enrollees in the first two days. That works out to exactly 0.00004 percent of the 7 million people that the administration would like to sign up during this open enrollment period.

What we haven't known, though, is who these people are -- and why so few of them are getting through to the enrollment process. A new survey out this morning of the uninsured from the Commonwealth Fund helps provide a few more answers.

"Obviously, the federal and state marketplaces have gotten off to a rough start, and I think that reality is reflected in these findings," says Sara Collins, vice president for the Health Care Coverage and Access program at the Commonwealth Fund.

There are a few other things the Commonwealth Fund survey tells us, too.

There's been a big increase in public awareness of the marketplaces. When the Commonwealth Fund last did this survey this past summer, it found about one-third of the uninsured knew that something called the health insurance exchanges would be launching in October. Now that they've actually come online, the survey shows a big spike, with 60 percent aware that there is an online portal to shop for coverage.


Awareness that there is financial help available on the marketplace, however, is still a bit lower. Fifty-three percent of the uninsured surveyed knew about that part of the health-care law.

That looks to be reflected, at least somewhat, in the shopping experience: Only about half of those who shopped for coverage applied for financial help. "I would have expected that to be a little higher," Collins says.

Seventeen percent of those potentially eligible have visited an insurance marketplace.  

The Commonwealth Fund includes an age breakdown, which shows that about one in five shoppers so far are people younger than 30 and half are between 30 and 49. Collins shared with me another age breakdown: 32 percent of those visiting the Web site were between 19 and 34. That's an important demographic in the White House's health-law planning: Officials there have estimated they need 2.7 million of an expected 7 million enrollees (38 percent) to be under 35, to keep premiums affordable.

Right now, the percentage of younger people turning to the Web site is a bit lower, but in range, of that goal.

One in five exchange shoppers signed up for a plan.

The biggest reason people aren't buying? Concerns about affordability.


This chart may be scarier for the administration than the technical glitches that have plagued HealthCare.gov. When those 76 percent of shoppers didn't enroll in coverage, the Commonwealth Fund asked why not. Thirty-seven percent said, unsurprisingly, that technical glitches kept them from signing up. But even more, 48 percent, said they weren't certain they could afford a plan.

Right now though, it's not clear what exactly this tells us. It could be people getting to the prices and not liking what they see, thinking it's too expensive. Or, it could reflect technical glitches that are preventing people from even seeing the prices.

"I think that's probably related to the technical issues, but we’ll obviously have to watch as things get fixed," Collins says. "We'll see how those responses change so we can more clearly get a sense of what's going on with people's experience on the site."

Technical glitches will, presumably, go away at some point. But the prices on the insurance marketplace aren't changing. If those are the big roadblock, the administration could have a bigger problem on its hands than a glitchy Web site.

Most of the potentially eligible say they'll shop sometime this year. But a sizable portion won't. 

The Commonwealth Fund found that 58 percent of those who could qualify to shop in the marketplace plan to do so by the end of open enrollment, whereas 39 percent describe themselves as "somewhat unlikely" or "very unlikely" to do so.

It's probably fair to read this as good news for the Obama administration. In order to hit its target enrollment goals, the White House doesn't need every uninsured person to sign up this year. In truth, it needs about 7 million people to buy private insurance, about 14 percent of the 47 million people who lack insurance coverage.

"That does show a determination on the part of the public," Collins says. "They're viewing this as a potentially transient problem. The issues they face now are probably less than they've faced shopping on the individual market in the past. They're willing to be patient and come back."

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

How HealthCare.gov failed to launch. "The project was hampered by the White House’s political sensitivity to Republican hatred of the law — sensitivity so intense that the president’s aides ordered that some work be slowed down or remain secret for fear of feeding the opposition. Inside the Department of Health and Human Services’ Centers for Medicare and Medicaid, the main agency responsible for the exchanges, there was no single administrator whose full-time job was to manage the project. Republicans also made clear they would block funding, while some outside IT companies that were hired to build the Web site, HealthCare.gov, performed poorly." Amy Goldstein and Juliet Eilperin in the Washington Post

Health Reform Watch Live! Starting at 1 p.m. today you can watch a whole bunch of health policy wonks, including Julie Rovner, Jonathan Cohn, Michael Cannon and myself, talk about the health-care law at University of Michigan's Center for Healthcare Research and Transformation. Webcast is available here.

Millions will qualify for no-premium health plans. "Supporters of the Affordable Care Act say that the availability of free-premium plans — as well as inexpensive policies that cover more — shows that it is achieving its goal of making health insurance widely available. A large number of those who qualify have incomes that fall just above the threshold for Medicaid, the government program for the poor, according to an analysis by the consulting firm McKinsey and Company." Reed Abelson and Katie Thomas in the New York Times.

Some insurers are sending subscribers misleading letters. "Across the country, insurance companies have sent misleading letters to consumers, trying to lock them into the companies' own, sometimes more expensive health insurance plans rather than let them shop for insurance and tax credits on the Obamacare marketplaces -- which could lead to people like Donna spending thousands more for insurance than the law intended. In some cases, mentions of the marketplace in those letters are relegated to a mere footnote, which can be easily overlooked." Dylan Scott in Talking Points Memo