Tip Sheets

The first health insurance marketplace numbers are in: What do they tell us?

Joanne Kenen
Joanne Kenen

By Joanne Kenen

Here’s a guide to understanding what the HHS enrollment numbers do and do not tell us at the end of the first month.

The bottom line: Enrollment

As of Nov. 2, a little more than 100,000 (to be exact: 106,185) had chosen a health plan – 26,794 through the federal site and 79,391 from the states. (Scattered reports from states in November suggest the rate is picking up but it’s too soon to be sure).

This is a very low number. No way you can spin otherwise. Does it spell disaster six months from now? No. But it is not a rosy start and it adds to public perception of crisis.

In addition, not everyone who selected the plan has paid for it. Payments aren’t due until mid-December. Will absolutely everyone in this category pay? Probably not.

Completed applications

846,184. And since some of those applications represent families, they account for 1.5 million individuals.

Advocates were buoyed by this number and disappointed that it was not more widely reported. It means that many people fought their way through the cyber-mess to complete an application and get eligibility determinations. Advocates see that as a sign that they are still shopping, thinking about and learning about plan options. We can see how that can be a promising sign that enrollment figures in December and January will be higher. However, we can’t assume that everyone who fills out an application will go on to get coverage. Some of those people will weigh their options and decide they don’t like any of them, that it’s too much money etc. We just don’t know.

Medicaid and CHIP

So far, 396,261 individuals have been determined eligible for Medicaid or the Children’s Health Insurance Program. Advocates love this number. It shows word is getting out about the low-income programs and there is demand for coverage. But it doesn’t solve the risk-pool problems in the exchanges. It’s separate.

March target

The administration wants 7 million in the exchanges by March 31, 2014. Remember this is a target – and it was actually cooked up by the Congressional Budget Office as their best guess of first-year enrollment. The exchanges don’t go up in smoke if it’s not met – at least not in actuarial smoke; political smoke is a whole different matter. What also will matter is WHO is enrolled, not how MANY. There are a variety of risk-adjustment mechanisms to help the health plans in the early years. But, for an insurer, 7 million near-retirement people with chronic conditions isn’t necessarily a better outcome than 5 million with a better demographic mix.


There have been 26.9 million unique visitors to the exchange websites. This is also a lot –and it can’t all just be journalists and health-industry curiosity seekers. It’s a lot of people wanting to get on the exchange websites and that’s probably a good sign for the administration.

(Unique visitors aren’t the same as total people — I am not a techie but a colleague who is patiently explained if you try from your home computer and your work computer, you’d count twice. But I would also imagine that if you were a navigator working from a laptop and trying to help numerous people, you’d only count once. Here’s PC Magazine’s explanation of how it’s hard to know exactly how many people a unique visitor number represents.)

What they haven”t told us

In the November HHS release we were not given information about age groups, gender, metal tiers (more expensive or cheaper plans). HHS says that will be forthcoming in the future.