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Healthcare.gov Enrollments to Date a Pathetic < 50,000

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No wonder the Administration has been tap dancing about results of the Obamacare launch. The Wall Street Journal reports that fewer than 50,000 people have enrolled in Obamacare through the Federal website to date. Mind you, this is a full six weeks after the launch date, so enrollments have averaged under 10,000 per week. This contrasts with the Administration’s estimate of 500,000 enrollments for the month of October (the assumption was that most people would put off making a commitment until closer to the deadline). Recall that the enrollment target is 7 million, and the enrollment period has been extended till March 31.

By contrast, the 14 states that have their own sites are having a bit more success, with 49,000 enrollees among them, according to Avalere, a consulting firm. The Administration is trying cheerily to say that late-in-the-game signups are normal. But even so, only 1/10th of the target population has created accounts (the figure bruited about is 750,000) and reports to date suggest that that may well include duplicate accounts.

And of course, the difficult of enrolling is producing adverse selection: for the most part, only highly motivated people, as in those who have high medical costs, are anxious enough to keep pushing with the site so difficult to use.

More details from the Journal:

In some states, such as California, customers have been able to fill out applications and select plans, but insurers haven’t received any of the enrollment data. Officials overseeing California’s exchange promised to begin transmitting enrollment data this month…..

Democrats acknowledge that the window is closing to fix the website and smooth out the enrollment process. Jeffrey Zients, who was named by President Obama late last month to lead the effort, has said the site would be repaired for “most users” by Nov. 30….

The tight timeline has health insurers worried. Already, insurers have said their incoming enrollees in the federal exchange are significantly older than anticipated. Because the law bars insurers from charging unhealthy customers higher rates, insurers must attract young, healthy customers to offset the costs of people who use more health services.

Update: Should have included this in the initial post. Compare this report with key points from Lambert’s post earlier today:

It’s actually OK that the numbers are low in absolute terms; the MA enrollment for RomneyCare was initially low, and built to the final deadline. There are two metrics that matter: First, the order of magnitude of the enrollees compared to projections. 494,620 vs 49,462 is just barely passing; 494,620 vs. 4,946 would be very bad or, in Washington parlance, a “concern”; and even I don’t think there will be 494 enrollees. Second, the actuarial soundness of the pool; if the entire pool has a pre-existing condition, the insurance companies can’t profit.

The total falls below Lambert’s “barely passing” since this figure includes November to date, while Lambert was anticipating the official report for HHS, which will cover October only (not only does November to date mean an additional 10, or 30% or so days, but enrollments are supposed to accelerate over time. So his 49,462 for October should be at least 30%, or more like 40% higher to be a true apples to apples. That would mean solidly over 65,000.

And the fear, that the enrollees are skewing heavily towards the unhealthy, appears to be being borne out. So this program is becoming the worst of all worlds: ordinary Americans are begin screwed through higher costs (r paying penalties) as insurers game the program, yet ironically, the insurers are still not coming out as well as they had hoped. If that is still true as of the close of enrollment, they’ll simply put through rate increases next year.

There is not amount of PR lipstick that Obama can successfully apply to this pig.

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33 comments

  1. Lambert Strether

    Key point: “The administration hasn’t said whether it will release demographic data such as ages when it announces the number of enrollees”; if you’re worried about an actuarial death spiral, that is the data you want to see (or conceal). See discussion of PR here. Note they’re an order of magnitude short of projection, which — it was my day to be kind — I labeled “barely passing.”

  2. Jackrabbit

    I think I saw a comment somewhere that the fatal flaw in Obamacare was the coverage for pre-existing conditions. Thus, young, healthy people can just wait until they have a problem before enrolling. For many/most its better to pay the penalty (for now) than enroll.

    Honestly, I haven’t followed Obamacare much but I am curious if there is truth to this ‘fatal flaw’?

    1. Ned Ludd

      Before Obamacare, several states – including New York and Vermont – had guaranteed issue requirements for individuals. Health insurance in those states was expensive, but AFAIK it didn’t appear to be any sort of fatal flaw. Someone who lived in one of those states would have a better perspective that I do.

      The only state where the market completely broke down was Washington state, which also instituted premium price controls in 1993. The insurance companies boycotted the state, refusing to cover individuals. They made an example out of Washington state to ensure that no other state followed their example.

  3. middle seaman

    Young people will enroll only if their insurance cost is small while the benefits are tangible. The cheap policies, the bronze and even silver, may be relatively cheap, but their benefits are ridiculously small. The bronze option should be eliminated and the silver improved.

    If Nov 30 will deliver a “decently” operating registration environment, we should have seen substantial improvements already. Lack of improvement so far, tends to indicate a much longer time frame for “decency.”

  4. diptherio

    “This contrasts with the Administration’s estimate of 50,000 enrollments for the month of October (the assumption was that most people would put off making a commitment until closer to the deadline).”

    I think you mean “500,000 enrollments,” otherwise the Admin nailed it…

    1. AbyNormal

      im remain steadfast…http://www.nakedcapitalism.com/2013/11/the-obamacare-rollout-and-organizational-dysfunction-in-the-administration.html#comment-1597626

      “If we knew all the laws of Nature, we should need only one fact, or the description of one actual phenomenon, to infer all the particular results at that point. Now we know only a few laws, and our result is vitiated, not, of course, by any confusion or irregularity in Nature, but by our ignorance of essential elements in the calculation. Our notions of law and harmony are commonly confined to those instances which we detect; but the harmony which results from a far greater number of seemingly conflicting, but really concurring, laws, which we have not detected, is still more wonderful. The particular laws are as our points of view, as, to the traveler, a mountain outline varies with every step, and it has an infinite number of profiles, though absolutely but one form. Even when cleft or bored through it is not comprehended in its entireness.”
      Thoreau

    1. jrs

      That’s aweful. I keep hearing people pimp that the ACA will help the self-employed, but when it lists the deductions you can use to lower your adjusted income, 401ks are allowed but IRAs aren’t. But wouldn’t most self-employed people be using IRAs as their only tax deferred retirement saving vehicle since they don’t have 401ks? So if one is actually doing well at self-employment they either fall a few or many dollars over the income limits and have to pay the entire of their healthcare costs or they just give up and get a job (which even *IF* the job doesn’t provide healthcare, at least might provide means like 401ks to shelter income from the AGI calculation).

      1. Dromaius

        Yes, self employed would often enroll in IRA unless they have another retirement plan (which they could potentially form).

        The one that really irks me is they can’t subtract the 1/2 of self-employment deduction from MAGI. That piece is the self-employed person’s equivalent of the employer portion of social security. Every person who works for someone else has that amt effectively taken from the income used to calculate MAGI (because the amount never shows up on the W2 as income at all). The self-employed is not allowed to subtract that money to calculat MAGI. It’s a travesty.

        The authors of the law wanted to harm the self-employed. No surprise since the law was written by big business.

    1. ian

      The problem I see with the thinking that if the ACA is just screwed up enough, it will bring on single payer is this: would you trust the folks who f’d it up so badly the first time to do it over? I certainly wouldn’t.
      The ACA can fail, just not too quickly.

  5. Sammy Maudlin

    Strikes me that the operational “problems” with healthcare.gov are a feature, not a bug. HARP was a failure, in large part, because lenders and mortgage insurers weren’t willing to step up and take the risk of refinancing underwater homes. So, access to the program was simply stonewalled. Were health insurers aware of an “actuarial death spiral” that was sure to occur if those most motivated to sign up – those with pre-existing illnesses and other “uninsurables” – were allowed to flood the system without enough “better risks” signing up as well? Is the whole “failure” of the rollout actually the system protecting itself?

      1. Sammy Maudlin

        Right, they did. Long game = further entrench the need of people to have health insurance, maximize customer base and future profits by making insurance “universal,” i.e. forcing everyone get it. Short game = make sure that short term profits are not unduly diminished by having to accept too many bad risks right at the outset. In other words, the insurance companies who wrote the law want to accept the benefit of “universal” coverage whilst avoiding the obligation of having to take everyone onto the books, no matter how bad an actuarial risk. Not that insurance companies ever think of creative ways to accept benefits while avoiding obligations.

    1. Dromaius

      Around 7,400 of the Washington number are insurance enrollees. The rest are Medicaid.

      http://orcasissues.com/state-affordable-care-market-enrolls-55000-in-october

      We have states like Oregon, where the Exchange online site can’t enroll people at all and DC where only 5 people enrolled. We have New York and California where you can’t even see the docs on the plans. All of these are likely going to come in with fairly low enrolees.

      But the 50,000 number DOESN’T include the states that have their own Exchanges. The number is only for the Federal Exchange.

    2. Ned Ludd

      The 50,000 figure only includes people who had “enrolled in private insurance plans as of last week”.

      The figure doesn’t include people in the 36 states who used the federal website to learn if they qualified for Medicaid, a federal-state health program for low-income people. Medicaid is being expanded in some of those states. The federal website cannot yet transfer information to the states about people who discover on HealthCare.gov that they are Medicaid-eligible.

      1. BondsOfSteel

        Also, there are another 100,000 in WA that picked a plan but didn’t fill out payment info.

        With just under 1,000,000 uninsured in WA, things are looking really good.

        That’s 5% signup in the first month with another 10% on the fence. It’s what the federal numbers might have looked like if their site worked.

    3. Ned Ludd

      As a sidenote, in Washington state, 8,000 people who signed up for private insurance will probably have to re-enroll. They “were told they qualified for more generous tax subsidies than they will actually receive… A technical glitch meant the Washington website sent the applicants’ monthly income to a federal hub instead of their yearly income, according to a report in The Seattle Times.”

      This is not a “technical glitch”. This is a defect in a system that was never properly tested.

      The exchange in Washington state, called “Healthplanfinder”, will soon have approximately 300 call-center staff “to handle calls seeking information and assistance with their applications”.

      A key goal is to significantly reduce the average wait time for callers, which is still about 20 minutes, [exchange CEO] Onizuka said.

  6. 12312399

    just a little reminder, universal health care is an explicit part of the Green Party platform.

    saying that the Democrats are the lesser of two evils is saying that you’d rather be stabbed in the back than shot in the face.

    i’d rather be shot in the face by Republicans. at least the Republicans are honest about it.

    1. Ned Ludd

      “If you stick a knife in my back nine inches and pull it out six inches, there’s no progress.” – Malcolm X

      Republicans knife you in the back. Democrats knife you in the back, pull it out partway, and expect gratitude.

    1. Mac

      Obama reads what he given or repeats what he has been told to peddle.
      He has no idea, problem is the folks feeding him stuff do not either

  7. Chibboleth

    Something that’s really bothering me about all the “Obamacare website doesn’t work” stories – why are none of them focusing on the contractor? It’s not like it was built by HHS or something. Speaking as someone who works in the software industry everything I’ve read and seen of the healthcare.gov rollout is depressingly and hilariously familiar. Totally inflexible deadlines and software projects really don’t mix very well at the best of times, and particularly not when you’re talking about a federal contractor.

    I would love for the media narrative on this to be “goddamn contractors” but it clearly isn’t going to be. A hundred years from now people will be saying the American system failed in large part because the government came to rely on a system of corrupt, incompetent private contractors to do pretty much everything.

    1. Yves Smith Post author

      They can’t blame the contractor because there was none. Seriously. They didn’t hire the tech analogue to a prime contractor. They had all the contractors working on the various pieces reporting to and coordinated by HHS.

  8. Ned Ludd

    In Minnesota, most of the people signing up through MNSure, the state’s insurance exchange, are poor and working class people who are discovering that they qualify for public insurance.

    Of about 11,000 sign-ups so far on MNsure, the state’s insurance exchange, nearly 9,200 qualified for public insurance plans — either Medicaid or MinnesotaCare. That compares with fewer than 1,800 who have applied for private insurance plans.

    Minnesota “has some of the lowest premium prices in the nation” for private insurance offered through its exchange. In spite of these comparably low premium prices, the private insurance plans are not getting much uptake.

    The article cautions: “Health care analysts warn that the trend, if it continues, would be unsustainable.” Obamacare was designed as a Trojan Horse to “break the two largest single-payer health-care systems in America”. If Obamacare, instead, helps people find out that they qualify for public insurance, the Democrats will be sure to find some way to “fix” this to make it sustainable (for private insurance companies).

  9. denim

    Compare to Romneycare signups in MA:
    “David Simas, a White House deputy senior adviser, in a conference call with reporters Tuesday pointed out that 123 people — just 0.3 percent of eventual enrollees — had signed up for the Massachusetts exchanges in the first month.” … …
    “Insurance is a tough sale,” said Jon Kingsdale, executive director of the Massachusetts Health Connector. “Nobody goes down to their broker on Saturday morning to smell the leather and test- drive this baby.”

    http://insurancenewsnet.com/oarticle/2013/10/30/on-defensive-over-health-law-obama-turns-to-romneycare-%5Bexaminer-the-washingt-a-412998.html#.UoIz-CdLmKU

    1. human

      Using a 4% total uninsured for a MA population of 6,500,000: https://en.wikipedia.org/wiki/Uninsured_in_the_United_States ; 6,500,000 x .04 = 260,000. Ideally, Mr Dimas’ newly enrolled to date should be at least 260,000 x .003 = 780.

      All “eventual enrollees”; 123/.003 = 41,000; which is only 15% of the states’ total uninsured (41,000/260,000)!

      These figures leave 85% of Massachussets’ uninsured uninsured. The figures of David Simas clearly do not add up to the sales pitches.

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