The Rest of the Story on Health Exchange Enrollment

This morning, the tally of enrollees in health exchanges is between 6 and 7 million.

Many of these will not finalize their paperwork until April 15, and many more might not pay their premiums.

Nonetheless, given the underwhelming rollout of Healthcare.gov, and well-funded campaigns in some states to discourage enrollment, the number is impressive. But the rest of the story is more important.

In coming weeks, these questions will be answered:

How many of these new enrollees will actually pay their premiums next month and be insured?

Are the new enrollees healthy or sick and in need of medical attention? How will the delivery system respond to these needs?

Did the penalty induce enrollment, or were other factors more important to individuals? Was it the attractiveness of subsidies or something else?

How will employers that provide health coverage assess the viability of health exchanges in their benefits strategies? Can these exchanges serve as a viable marketplace for employee insurance purchases (and allow employers to shift purchasing responsibility to their employees)?

Will troubled state exchanges (like Oregon, Maryland and others) try to fix their platforms, outsource to successful state exchange operators (like Kentucky/Connecticut) or invite the federal government to take over? What’s the long-term plan for the 14 state-run exchanges, and how will they be funded? And what’s next for Healthcare.gov? Is it fixed?

What is the long-term impact of health exchanges on the private health insurance industry? Is it a critical marketplace for their products? What’s the future of the individual insurance market?

And was the goal for health exchange enrollment—‘to reduce the ranks of the uninsured’—achieved if it turns out a significant majority of the new enrollees were previously covered?

No doubt, the muscle of the administration in tandem with efforts in many states contributed to the avalanche of late enrollment in March. Skeptics about the Affordable Care Act will likely discount the effort, noting it’s too soon to know the full impact of the enrollment push.

And proponents are unlikely to say “I told you so” because they’re are sensitive to the political risk associated with support of the ACA.

The enrollment milestone is important because it signals the continued viability of the Affordable Care Act and assures its prominence in the upcoming election cycle. But it’s only a small part of the story of health reform and the role private insurance plays. There’s much more to the story.

Paul Keckley, PhD is an independent health care industry analyst, policy expert and entrepreneur. Keckley most recently served as Executive Director of the Deloitte Center for Health Solutions and currently serves on the boards of the Ohio State University Medical Center, Healthcare Financial Management Leadership Council, and Lipscomb University College of Pharmacy. He is member of the Health Executive Network and advisor to the Bipartisan Policy Center in Washington DC.  Keckley writes a weekly health reform newsletter, The Keckley Report, where an earlier version of this post originally appeared.

3 replies »

  1. Medicaid is not insurance, it is welfare. Plans obtained through exchanges are not insurance since there is little to no risk management and ongoing conditions, catastrophic, chronic, or otherwise are not considered in the risk unit pricing. Mostly, it is prepaid, tax payer subsidized, limited access, health care, or, again welfare.

    So, if it’s not insurance, am I uninsured? If everybody is uninsured is anybody uninsured. Say what you will about us, but I won’t sit and listen to you bad mouth the United States of America…

  2. Three reasons one would sign up for Obamacare:
    1. It’s a great product and people are flocking to get it.
    2. Older and sicker/pre-existing conditions, need health insurance badly.
    3. Middle aged and healthy, but responsible adult, doesn’t absolutely need it but being cautious, doesn’t want to risk penalty.
    4. Young and healthy, doesn’t really need it, but not willing to have to pay a penalty.
    I suspect mostly 2,3, and 4 are signing up, with 4 being the least likely.

    Between Medicaid signups and Obamacare signups, currently the guess would be close to 13 or 14 million, out of between 40-45 million previously uninsured. That doesn’t account for at leat a couple million who lost their insurance (if you like it, you can keep it) and signed back up so they would be covered. We also don’t know how many will follow through with payments and continue to pay for their plans.
    I’m sure the administration is kicking up their heels and laughing at the naysayers right now.

    Unfortunately, having health coverage does not mean you will get care, or good care, or timely care. Nor does it mean that it will be less expensive to be sick, which is the REAL problem. No, only time will tell us that.