Low enrollment expected to amp up pressure to tinker with ACA

(Story updated at 6:24 p.m. ET.)

HHS' announcement that fewer than 27,000 people signed up for insurance coverage through the federal HealthCare.gov website in the first five weeks of its problem-plagued rollout is likely to intensify political pressure on the Obama administration to grant relief to Americans facing cancellations of their current insurance policies and a tax penalty if they fail to get coverage by March 31.

The 26,794 people signing up for private plans through the federal exchange works out to an average of roughly 750 enrollees in each of those 36 states that are using the online marketplace built by the federal government.

Nationally, a total of more than 106,000 individuals signed up for coverage through the exchanges in all 50 states plus the District of Columbia. But roughly three-quarters of those enrollees came through the state-run exchanges in 14 states and the District of Columbia, which generally have experienced fewer technological problems. California had the highest number of enrollments, with just over 35,000.

The enrollment figures are far below the 500,000 subscribers that the Obama administration had estimated would obtain coverage in the first month of enrollment in October. But many experts say it's too early to say how many people ultimately will sign up because the deadline for enrollment is still months off and it's common for people to put off making an insurance enrollment decision.

Addressing reporters Wednesday afternoon, HHS Secretary Kathleen Sebelius emphasized that HealthCare.gov is working and getting better every day. She also said it's reasonable to expect that enrollment figures will continue to increase, just as they did in Massachusetts seven years ago when that state implemented its own insurance expansion through an online health plan marketplace.

Enrollment in public programs is proceeding much more briskly. Nearly 400,000 individuals were determined to be eligible for either Medicaid or the Children's Health Insurance Program during the first six weeks of enrollment.

Insurance companies don't typically count a subscriber until their first payment has been processed. But the HHS figures include anyone who has selected a coverage plan, regardless of whether they've made any payments.

By HHS' count, 975,407 individuals have gone through the process of applying for coverage and receiving an eligibility determination but have not yet chosen a health plan.

“I don't find it discouraging that people have gone through the process and haven't chosen a plan,” Sebelius said. She noted that buying health insurance is a very different consumer experience than, say, shopping for a toaster. When choosing a health plan, consumers want to know lots of things, such as whether their physician is included in a particular plan's network. “In Massachusetts, people visited the site multiple times before they made a decision,” she said.

House Ways and Means Committee Chairman Dave Camp (R-Mich.) said the HHS enrollment figures were “inflated” to include those Americans who are just shopping for a health plan. “Even if this data was an accurate picture, the administration would need to enroll 68,000 people per day to meet their year-end goal,” he said in a written statement Wednesday. “However, the website isn't even designed to handle that much traffic and is currently capable of only handling less than half that much.”

But Rep. Sander Levin (D-Mich.), the senior Democrat on that committee, said the new enrollment numbers show a “meaningful start” to address the country's long-standing need for expand healthcare coverage and access. “Despite major logistical challenges and in the face of virulent opposition from Republicans in Congress, the new marketplaces have generated widespread interest among Americans, with more than 1.5 million having already applied for coverage,” Levin said in a written statement. “Now, more than ever, it is critical that the technical problems be resolved so that everyone wanting to purchase coverage through the marketplaces is able to do so.”

Levin also took a jab at legislation proposed by House Energy and Commerce Committee Chairman Fred Upton (R-Mich.) that the House will vote on this week. It would allow people who have individual-market health plans that are being canceled to keep their plan if they choose. Levin said Upton's bill would lead to “dramatic premium increases for the marketplaces in 2015 and beyond” and would also take the country back to a time when insurers “can discriminate on the basis of pre-existing conditions.”

Paul Ginsburg, president of the Center for Studying Health System Change, lamented the low enrollment figures so far and said he fears that the continuing woes of the federal insurance exchange serving 36 states will lead to policy changes that could ultimately undermine the Affordable Care Act. “The federal exchange figures are just awful,” Ginsburg said. “I think the threat that they pose to the Affordable Care Act is really the threat of what types of ill-considered policies could result from panic.”

Three main policy changes have been proposed by Republican and Democratic members of Congress in recent weeks. They include delaying the individual mandate and its associated tax penalty for failing to obtain coverage; extending the open enrollment period beyond the March 31 deadline for getting coverage without having to pay the tax penalty; and allowing individuals with plans that have been canceled to keep their plan through 2014.

Ginsburg argued that the third approach, which has gained support from some congressional Democrats and from former President Bill Clinton, could do the most damage by increasing the proportion of sicker people in the exchange plans. The White House so far has rejected that option.

“If you let them keep their plan for a year, then there's going to be intense pressure to let them keep their plan for another year because it will be election season,” Ginsburg said. “This could actually start breaking up the risk pool and could really undermine the workings of the program.”

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