Questions remain despite latest ACA enrollment numbers, projections

Joanne Kenen

About Joanne Kenen

Joanne Kenen, (@JoanneKenen) the health editor at Politico, is AHCJ’s topic leader on health reform and curates related material at healthjournalism.org. She welcomes questions and suggestions on health reform resources and tip sheets at joanne@healthjournalism.org. Follow her on Facebook.

The latest ACA enrollment report (and the CBO projection that 6 million people would sign up for exchange coverage by March 31) is a classic half-full, half empty scenario.

Half full because the 3.3 million selecting exchange plans is a way better number than what many expected last fall when the sign-up portals were not working. Remember when only about 100,000 had chosen a plan in the state and federal marketplaces in October?

Half empty because 3.3 million may be on track to 6 million – but 6 million is less than the 7 million that the administration earlier had embraced as a goal. And 6 million or 7 million (plus another 8 million in Medicaid and CHIP) still leaves millions of people uninsured.

And, as Charles Ornstein and others have noted, the administration doesn’t tell us everything we need to know:

Missing from the report are details about how many of the consumers who signed up actually paid for their first month’s premium, a requirement to actually be insured. The document also does not say which insurance plans consumers chose, a metric needed to determine how the insurance market is shaping up. And it offers no details about how many of those signing up for coverage were previously uninsured, the key goal of the law.

These answers may differ sharply from one state to another.

Nevertheless, some of the reporting I’ve seen about how many people were previously uninsured has a bit of a gotcha quality. There was never an assumption that everyone getting covered in the new market was uninsured before – although the White House was never* (to my knowledge) very explicit about the newly insured versus the differently insured in the new health insurance marketplaces.

In fact, during the fall there was a lot of emphasis on how the website problems were creating enrollment obstacles for insured people who were leaving the individual market and moving to the marketplaces, either because they wanted to or because plan cancellations gave them scant choice. And we may find – although we don’t have the data now – that relatively more people signing up in the fall had insurance in the old individual market and were trying to maintain coverage, and that relatively more uninsured people are getting covered now. CBO is predicting a net decrease of 13 million uninsured under the ACA this year.

* Here is the latest forecast from the Congressional Budget Office. The numbers don’t all match up to other surveys and census data you may have seen. CBO reports net changes in different segments of the insured population and net gains in coverage, but doesn’t directly say how many people covered by the ACA directly were uninsured or uninsured in the past. I have not seen a specific government report breaking that down; if you have, please share it.

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