I keep waiting for the final official HHS report on enrollment and the state and demographic breakdowns, but since we don’t yet have it (Charles Gaba reports it should come out at 2:15 p.m. today) – let’s just recap what we do and don’t know about enrollment as of the end of April. To find out more, talk to your state insurance commissioner, exchange officials, the Medicaid office, brokers and the major insurers.
Just over 8 million in exchanges: This is the sign-up number – as critics of the law keep reminding us, not everyone has paid, or will pay. AHIP’s Karen Ignagni told me the expected rate is about 85 percent payment, 15 percent nonpayment (and no, young people are not failing to pay at way higher rates based on what we know so far). If that 15 percent figure is right, enrollment is still about 6.8 million.
Plus people will continue to go in and out of the exchanges. If you have a baby, get married or divorced, turn 65 (leaving exchange for Medicare), turn 26 (leave mom/dad’s plan for the exchange) change jobs etc etc, you can still enroll (or unenroll). The number will be in flux. There will probably be a net rise but no one is sure because it’s a new landscape.
3 million plus plus plus in Medicaid: This is the federal number as of late February but the final number will be much larger. Some people are signing up through the exchange, some through state agencies, millions more were deemed eligible but didn’t complete enrollment – they numbers are really in flux. Plus there is no “enrollment season” for Medicaid enrollment. It goes on all year.
Estimated roughly 8 million gain in Employer-Sponsored Insurance (ESI): This seemed high to me until an insurer in Massachusetts told me there was a similar spike when that state did its reform. (This is a RAND estimate and I haven’t seen it elsewhere.) The increase is probably both because of the mandate and the publicity surrounding enrollment, plus the improvement in the economy and the job market.
More or less 3 million “under 26-ers” – young adults staying on their parents plan: Remember they wouldn’t all be uninsured without this option. Some would go into the exchange, some would get covered through colleges/universities, some would take up the employer insurance.
“Off exchange” coverage boost: This is also in the millions (I’ve seen estimates ranging from 5 to 8 million.) This is people who are getting ACA compliant plans outside the exchanges, usually people who don’t qualify for subsidies. But most of them had insurance before.
This of course is the insured – it doesn’t tell us who is newly insured, who was uninsured before. That is a hot political topic and will be for some time to come. We don’t know for sure, although more polls and data are coming in, along with statements from the health plans and the few states that do collect this data, that millions of people are newly insured. I’ll come back to this question as we get more surveys and reliable information.