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Healthcare Business News enrollment topped 100,000 in November, HHS says

By Paul Demko
Posted: December 11, 2013 - 9:00 am ET

More than 100,000 individuals selected a private insurance plan through the federal online marketplace in November, HHS announced Wednesday. That's roughly four times the enrollment total during October, when the website was largely dysfunctional. But it was far short of the levels needed to meet the Obama administration's projection of 3.3 million enrollees by Dec. 31.

Enrollment in the 15 state-based exchanges continued to outpace activity in the federal marketplace in November. More than 250,000 individuals had selected private coverage through the state-based marketplaces in 14 states and the District of Columbia by the end of November.

The numbers were released just before HHS Secretary Kathleen Sebelius was set to testify Wednesday morning before the House Energy and Commerce Committee.

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That means roughly 365,000 individuals chose a private plan during the first two months of operations. That's just over 5% of the seven million enrollments that the Congressional Budget Office and the administration projected would take place by the end of the March 31 open enrollment period.

With the Dec. 23 deadline approaching for purchasing insurance that will take effect Jan. 1, enrollment through the federal and state websites is expected to continue to swell. The administration announced at the start of December that was functioning well for the “vast majority” of users as it had promised, and news reports from around the country support that claim, though issues linger in accurate transmittal of enrollment data to insurers. The Washington Post reported that more than 50,000 individuals signed up for coverage in the just the first three days of December, although HHS has not confirmed that number.

“The website is night and day from where it was on October 1,” said Michael Hash, director of HHS' Office of Health Reform, on a call with reporters. Hash stressed that there are still more than three months left in the enrollment period and that many individuals, particularly younger and healthier people, are expected to wait until the last minute to sign up for coverage. “We think we're on track and we will reach the total that we thought,” he said.

Federal officials released other metrics that indicated significant progress in the rollout of the exchanges. In the first two months of operations, 1.8 million applications were completed through the state and federal marketplaces. Those applications represent potential coverage for 3.7 million individuals. In addition, more than 800,000 individuals have been deemed eligible for either Medicaid or the Children's Health Insurance Program.

John Holahan, a health policy expert with the left-leaning Urban Institute, points to those incomplete enrollments as evidence of pent-up demand for coverage, especially given the federal web site's problems. "What's the trajectory going forward?" Holahan asks. "I think you have to think of it as optimistic, but it leaves a lot of unanswered questions."

Among the state-based exchanges, California led the way with 107,000 individuals who have selected a private plan, followed by New York with more than 45,000 individuals signed up for coverage. Washington state, Kentucky, Connecticut, and Colorado had the next biggest totals.

Among the 36 states relying on the federal exchange, Florida and Texas had the most enrollments, with about 18,000 and 14,000, respectively, despite strong resistance from those states' Republican leaders to enrollment efforts.

But skeptics point out that the enrollment figures released by HHS include many individuals who haven't actually completed the process of enrolling in coverage. Stephen Parente, a health policy expert at the University of Minnesota, pointed out that insurers must receive accurate enrollment and premium subsidy data from the exchanges and that the new customers' first premium payment must be received before the coverage will actually be active. “Without that holy trinity, you are counting whispers of success,” said Parente, who was an adviser on Republican John McCain's 2008 presidential campaign.

In particular, there have been widespread concerns about the accuracy of the 834 data forms that insurers rely on to enroll new customers. Last week the CMS acknowledged that there were problems with the 834 forms for roughly a quarter of individuals who enrolled in coverage in October and November. That works out to nearly 35,000 problematic forms.

CMS spokeswoman Julie Bataille reiterated that the agency's top priority is fixing those back-end transmittal problems so that insurers receive accurate information. “That is a daily conversation that we are having directly with issuers,” Bataille said.

Joseph Antos, a health policy expert with the conservative American Enterprise Institute, acknowledged that the improvements to the federal website may have eased pressure to make changes to the law, particularly among swing-district congressional Democrats running for re-election in 2014. But he expects that pressure to ramp back up as legislators return to their districts over the holiday. “They're going to be in the sights of some pretty angry people,” Antos said. “I think it's all going to come back.”

The new HHS report provided no information about the age makeup of the exchange enrollees. Many experts say it's important that about one third of the enrollees need to be younger and healthier people to offset the medical costs of older and sicker enrollees.

Follow Paul Demko on Twitter:@MHpdemko

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