Should you bet on America? (Photo by Karen Bleier/AFP/Getty Images)
Should you bet on America? (Karen Bleier/AFP/Getty Images)

The District of Columbia's insurance marketplace has enrolled exactly five people in health plans, according to documents released by the Senate Finance Committee on Friday.

That sounds like bad news for our hometown exchange. But, when you dig into the numbers a bit further it turns out -- as is true with most health policy issues -- the issue is a bit more complicated.

First things first: What the Senate Finance Committee reported Friday were letters from the insurers who sell on the DC Health Benefit Link: CareFirst BlueCross BlueShield, Kaiser Permanente, UnitedHealthcare and Aetna.

They reported quite low numbers.

"Two people have enrolled," the letter from CareFirst BlueCross BlueShield said.

Kaiser Permanente submitted what might be the health policy's most simple chart ever.

The DC Health Link contends that these response letters don't tell the entire story.

"That is not an accurate depiction of the strong level of interest in the District of Columbia in obtaining quality, affordable health insurance," DC HealthLink spokesman Richard Sorian wrote in an e-mail.

He says that, as of Oct. 21, 321 people who created accounts selected a health plan for enrollment. Think of this as dropping an item in your shopping cart on Amazon (which is owned by the same person as The Washington Post, Jeff Bezos). Among those, 164 people have asked for an invoice from the health insurance plan that they selected.

Health insurers aren't notified of these invoices. They only get an enrollment form, from the DC health exchange, when the individual actually pays the first month premium.

"Consumers have until Dec. 15 to finalize their selection by paying their first month’s premium in order to have coverage on Jan. 1, 2014," Sorian writes. "We are very pleased with the strong, enthusiastic response from the residents and small business owners in the District.”

In the end, this boils down to what is the best metric to gauge interest in the health law exchanges. Health law supporters tend to prefer to look at something like consumers who have selected a plan but may not have actually paid for it quite yet. They contend that, given that premiums aren't due until Dec. 15, it's not reasonable to expect people to pay right away.

As Rhode Island's exchange director put it in late October, "The idea that people are going to do layaway purchasing three months out goes against the American way."

Health law opponents, meanwhile, tend to argue that paying a premium is the best metric -- it's the step that guarantees you're actually enrolled in the insurance plan, and will begin to receive benefits from that carrier.

Both metrics can be used to each side's advantage, and you can expect this to keep happening across the country as states continue to release enrollment information.


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