4 Hidden Mysteries in the Obamacare Enrollment Numbers
Policy + Politics

4 Hidden Mysteries in the Obamacare Enrollment Numbers


Health and Human Services Secretary Kathleen Sebelius took to Capitol Hill on Wednesday to tout Obamacare enrollment approvals, telling lawmakers that the total number of people who have selected plans is now nearly 365,000, three times the amount that signed up in October.

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But a deeper dive into the numbers released by HHS raises questions about just how successful the Obama administration’s effort to enroll 7 million people by the end of March will really be. There are also new questions about whether the White House will be able to meet its goal of providing insurance to the poor. And the pool of young, healthy uninsured people is much smaller than the administration suggests, raising the risk of an insurance rate spike.

Here are four mysteries hidden in the details of November’s enrollment numbers:

1. According to the report released by HHS, a full 40 percent of people who signed up for insurance qualified for a government subsidy to help them pay for it. Under the terms of the law, Americans who make under 400 percent of the federal poverty level can get a tax credit to help pay for insurance. People who make less than 250 percent of the federal poverty level can get a subsidy to help with out-of-pocket medical expenses.

Michael Hash, director of the Office of Health Reform at HHS, said Tuesday evening that the administration expected 90 percent of the people who sign up to qualify for a tax credit. So if only 40 percent of enrollees are eligible, it means that poor people and young people who are healthy but not making a lot of money aren’t signing up.

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“Some of those are certainly people whose insurance policies weren’t renewed and are higher income people with preexisting conditions. Some of them are older higher-income people who are risk averse. They want to have coverage,” said Tim Jost, a health policy expert at Washington and Lee University.

2. According to HHS, 1.9 million people completed applications, but only 365,000 actually chose a plan. Yet HHS said that these 1.9 million applications represented 3.6 million people. So if the remaining 1.535 million people sign up for the plan, adding millions to the list of enrollees, Obama would be halfway to his enrollment goal.

Related: Millennials: Obamacare for Thee, but Not for Me

3. The Obama administration doubled down on its goal to sign up 7 million people, despite being well behind its targets.

“We think we’re on track,” Hash said. “We’re only two-and-a-half months into a 6-month open enrollment period. We expect a bulk of enrollees will occur toward the end of the open enrollment period.”

It’s unclear why the administration continues to stick to the 7 million target. The Congressional Budget Office says the final number of enrollees matters much less than the demographics of the enrollee pool. Approximately 40 percent of all enrollees must be “young invincibles,” or healthy millennials ages 18 to 34 who do not have expensive medical bills in order to prevent a spike in insurance rates, no matter how many people enroll.

4. The way the White House characterizes young invincibles who need to sign up for the plan is misleading. It excludes those age 18 to 26 who remain on their parents’ plans.

When you factor in this wrinkle, the size of the population that’s needed to sign up shrinks considerably. By ruling out young people with families, those who remain on their parents’ plan, and those whose income is above the subsidy threshold of $45,960, the size of the population shrinks to 4 million, according to a study by Adrianna McIntyre, a graduate student in public health at the University of Michigan, and Josh Fangmeier, a consultant for the Center for Healthcare Research & Transformation in Ann Arbor, MI.

That means the White House needs to convince 67.5 percent of them to buy insurance to meet its goal of enrolling 2.7 million young people.

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