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State exchanges, when working, helped boost enrollments


By Paul Demko
Posted: May 5, 2014 - 3:30 pm ET
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States that opted to establish their own exchanges—and managed to avoid debilitating technical problems—had some of the highest levels of enrollment in the country during the recently completed sign-up period.

But some large states, including Florida, that opted to rely on the federal HealthCare.gov website also easily outpaced projected enrollments, two recent analyses show.

States operating their own exchanges saw 121.2% of projected enrollments, according to an analysis of enrollment data by researchers at the Urban Institute. For states relying on the federal exchange, that figure was 112.5%.

Vermont had by far the greatest level of success at signing up individuals, with enrollments reaching 280% of projections, according to the Urban Institute. Just two states—Massachusetts and Hawaii—failed to reach even 50% of estimated 2014 enrollments. Both of those states experienced severe technical problems that prevented many individuals from signing up through their exchanges.

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“Once those IT problems get resolved they are likely to look much more like the other state-based exchanges,” said Matthew Buettgens, a senior research analyst at the Urban Institute. “The states that are taking responsibility for the health insurance marketplaces are generally seeing a lot of success.”

The Urban Institute calculated its own enrollment projections based on demographic and economic data for each state.

Avalere Health utilized a slightly different system to conclude that 22 states exceeded enrollment projections for the sign-up period. The research and consulting firm relied on the Congressional Budget Office's projection of 6 million enrollments and assumed that 85% of the 8 million individuals who signed up for coverage will follow through with their first premium payments. That would lead to a total enrollment pool of roughly 6.8 million individuals.

Among the states that exceeded enrollment projections, six operated their own exchanges, according to Avalere's analysis. Leading the way for the state-based exchanges was California, with 186% of anticipated enrollments.

But some states that didn't establish their own online marketplaces didn't opt to expand Medicaid and did little to encourage outreach efforts to the uninsured also saw larger than anticipated enrollment figures. Florida had nearly 1 million enrollments. That was roughly 200% of Avalere's projection and 167% of the Urban Institute's estimate.

North Carolina was another state where enrollments were well ahead of projections despite little effort by state officials to implement the law. Both Avalere and the Urban Institute calculated that North Carolina had enrolled roughly 50% more individuals than anticipated.

Elizabeth Carpenter, a director of Avalere's health reform practice, said, “The big message remains that the enrollment picture of exchanges really is a region specific question. You can't look at the national numbers and get a sense of what's going on in any single state.”

The Urban Institute's Buettgens reached a similar conclusion. “The question is what is driving some of these differences?” he said. “I think it's a bit premature to really judge that now.”

Follow Paul Demko on Twitter: @MHpdemko


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