Even if enrollment doesn't reach 7 million by Monday night, it could by the mid-April expiration of a window the CMS has extended to consumers whose efforts to enroll have been thwarted by technical difficulties.
The extension is good news for those living in the 36 states relying on HealthCare.gov as the primary enrollment portal. In the last few days there have been reports of site outages and people being asked to come back later due to overwhelming traffic on the site. The latter occurred Monday as more than 100,000 people were trying to log in to the system at the same time. With so many people on the system at once, some users had trouble creating new accounts, a CMS official said.
States are giving residents various forms of leeway to make sure as many as possible signed up. While some are only granting extra time to those who have a pending application in the system, others are accepting applicants' word that they made a good faith effort to sign up.
Experts continue to warn, however, that being enrolled isn't the same thing as having coverage because a premium must be paid before medical services are reimbursed.
The gap in those numbers may be narrowing. Benaissance, a third-party billing firm that works for 100 insurers selling plans through marketplaces in 18 states, six with their own marketplaces and 12 relying on the federal system, said its tally of people who have paid a premium is much higher than the 67% it estimated in early January, although the firm was unable to provide a figure.
Shoppers in recent weeks have been much more serious about getting coverage, according to Mark Waterstraat, chief strategy officer at Benaissance. Some applicants in the fall were simply going through the process to see if the site worked, he said.
Officials from state health plan associations in New York, Texas and Virginia would put the amount of consumers paying at more than 85%. New York has seen high payment rates thanks to an aggressive outreach campaign, according to Leslie Moran, a senior vice president at the health plan association in the state.
The lack of payment isn't always the fault of consumers. In Louisiana “premiums are coming in slow because of a one- to two-month lag before applications are sent to plans from the exchange,” said Jeff Drozda, CEO of the Louisiana Association of Health Plans.
Another issue is whether the plans are getting enough 18- to 34 year olds to balance out the risk pool. Plans are indicating anecdotally that they've been showing up in greater numbers in recent weeks, but it's unclear if the Obama administration will reach its goal of having them represent 35% to 40% of the total enrollees, according to Dan Mendelson, CEO of consulting firm Avalere Health. They made up just 25% of the enrollees at the end of February.
A significant jump in young applicants is unlikely because young people can now stay on their parents' insurance until they're 26 and the administration is allowing people to keep plans that don't comply with the ACA through 2015. These cheaper, bare-bones plans are popular with younger consumers, said Doug Gray, executive director of the Virginia Association of Health Plans.
“Reaching the scenario where 35% to 40% of young people are enrolling is unlikely as long as they have other options,” Gray said.
However the final numbers shake out for the first open enrollment under the law, Democrats will have little to fear during the upcoming midterm elections because the administration reached the revised goal of 6 million laid out by the Congressional Budget Office, according to Yevgeniy Feyman, a fellow at the Manhattan Institute, a conservative think tank.
Feyman personally estimated that the exchanges wouldn't draw more than 5 million people during the first open enrollment period because of high premiums and fear of the HealthCare.gov enrollment portal after its disastrous launch.
“I'll admit my prior more pessimistic predictions didn't come true,” Feyman said. “I'm happy about that.”
Follow Virgil Dickson on Twitter: @MHvdickson