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85% of Obamacare enrollees received financial assistance, Sebelius says


By Paul Demko and John N. Frank
Posted: May 1, 2014 - 3:00 pm ET
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(Story updated at 4:15 p.m. ET.)

HHS Secretary Kathleen Sebelius for the first time unveiled demographic details (PDF) about the more than 8 million people who have signed up for health insurance through state and federal exchanges.

The vast majority of those enrolling, 85%, received financial assistance. Those receiving assistance needed to report if they had insurance coverage prior to enrollment. Of the 5.2 million who applied for financial assistance through the federal exchange, 13% said they had coverage at the time of application.

Sebelius hailed the enrollment data as evidence that the administration's “unprecedented” outreach efforts had paid off. “We knew from the beginning that reaching the uninsured would require a unique approach and we were determined not to run everything from Washington,” said Sebelius, who announced her resignation last month.

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Among the mountain of data HHS released were that 34% of the more than 8 million who signed up for plans through state and federal marketplaces were under age 35 and 28% were between 18 and 34. The enrollees were 54% women.

Of those who reported their race or ethnicity, 62.9% were white, 16.7% were African-American, 10.7% were Latino and 7.9% were Asian.

In terms of plans selected on both the federal and state exchanges, 20% chose Bronze plans, 65% Silver, 9% Gold, 5% Platinum and 2% Catastrophic. Looking only at state exchanges, 25% picked Bronze, 58% Silver, 9% Gold, 7% Platinum and 2% Catastrophic. A higher percentage of women than men selected silver plans, 71% to 67%, while a higher percentage of men selected Bronze plans, 19% to 16% of women.

A March enrollment surge produced 3.8 million new enrollees, including 1.2 million young adults ages 18-34.

Some states that had seen sluggish enrollments during the first five months of exchange operations saw marked spikes in the final weeks. In particular, Georgia, Florida and Texas saw enrollment more than double in the final month. Nationwide, 47% of enrollments occurred after March 1. The enrollment period officially closed on March 31, but state and federal exchanges allowed people who had started applications to complete them after that date.

The federal exchange, which handled sign-ups for 34 states, enrolled 5.4 million people in coverage. Roughly 2.6 million came through the online marketplaces operated by 16 states and the District of Columbia. Nearly a quarter of all enrollments, 1.9 million, were through California's exchange.

Medicaid, CHIP gains reported

The administration also indicated that 4.8 million more people are enrolled in Medicaid and the Children's Health Insurance Program than at the start of the open enrollment period. However, it remains unclear how many of those individuals were newly eligible for the Medicaid program. States had the option of expanding Medicaid eligibility to individuals with incomes up to 138% of the federal poverty threshold, and roughly half the states have opted to do so.

“Across the country Americans will continue to sign up for Medicaid coverage,” Sebelius said. “In fact, many will be eligible for the very first time.”

The numbers should be viewed with a couple of other caveats in mind. The CMS has not released any data on how many of the 8 million exchange enrollees have actually made their first premium payments, which is necessary for coverage to actually take effect.

A report issued Wednesday by the House Energy & Commerce Committee indicated that a survey of insurers revealed that only 67% of individuals who signed up for coverage actually followed through with premium payments as of April 15.

The Obama administration said the House committee's number isn't accurate, and it's significantly lower than the rate suggested by most insurers that have commented publicly on the matter. On Wednesday, for example, WellPoint executives said that roughly 90% of the publicly traded company's exchange customers were following through with payments.

The report includes the first data from the CMS on how many enrollees were previously uninsured, but administration officials cautioned that the data may not be reliable. Applicants who sought financial assistance for plans obtained through the federal marketplace were required to say whether they previously had coverage. Of those 5.2 million enrollees, only 13% indicated that they already had health insurance.

Previous analyses have suggested much lower numbers of exchange enrollees were previously uninsured. In New York, one of the few states to track the number, two thirds of enrollees through early February indicated that they were previously uninsured. And a report issued last month by the RAND Corp. suggested that nationwide only about a third of exchange enrollees previously lacked coverage.

“With that kind of variability it's hard to trust any of these numbers,” said Mike Hash, director of the Office of Health Reform at HHS.

Follow Paul Demko on Twitter: @MHpdemko

Follow John N. Frank on Twitter: @MHJFrank


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