Health Care
4:07 pm
Wed November 13, 2013

The Health Care Numbers Are Out, And They're Disappointing

Originally published on Thu November 14, 2013 10:46 am

The Obama administration released its much anticipated enrollment numbers for the first month of the troubled HealthCare.gov website Wednesday. And as predicted, the numbers were disappointing.

Just over 100,000 people managed to navigate the process and choose a health plan between Oct. 1 and Nov. 2 — 106,185 people, to be precise.

But barely a quarter of those, 26,794, enrolled through the federal website that's signing up people in 36 of the states. The rest enrolled through state marketplaces.

Earlier this week, people were leaking numbers that suggested that the number who enrolled via the federal exchange was about 40,000; 26,794 is even lower than that. On the other hand, what it really tells us is that the HealthCare.gov website wasn't working, so people couldn't choose a plan. That's not exactly breaking news.

On the state side, some states have been reporting their enrollment numbers all along. The one state we hadn't heard from was California. On Wednesday, federal officials reported that 35,000 people had enrolled in California — nearly half of the 76,391 total for the 11 states included in this report.

Questions remain, of course, including exactly what the administration is counting in these numbers.

In order to be formally counted as enrolled in a health plan, at least by an insurance company, you have to pay the first month's premium. But coverage doesn't begin until Jan. 1 at the earliest. Very few people are going to sign up in October and front out money three months in advance. So the administration is counting what are being called "shopping cart" people. They are those who have completed the enrollment process and chosen a plan but have not necessarily paid their first month's premium.

We now know that a lot of people are qualifying for Medicaid coverage or the Children's Health Insurance Program; 396,261 people have been deemed eligible for these programs so far. About 213,000 have enrolled through the state exchanges, and 183,000 on the federal exchange.

That's probably because in some states there was a big outreach effort to find people eligible for Medicaid or children's insurance. Also, the part of the state and federal exchanges that determines eligibility for Medicaid was working pretty well in October, compared with the part on the federal website that determines subsidies.

Just about every health care analyst points out that you shouldn't expect a lot of people to sign up during the first month of a six-month sign-up period. So the numbers probably would have been pretty small even if everything had been working just fine.

What this does tell us, however, is that there will be more pressure on the system, particularly the federal website, as we go forward. That's especially true if there's a surge of people who want to have insurance that begins Jan. 1. They have to sign up by Dec. 15.

And if that website isn't working as promised by the end of this month — or even if it is — there could be a huge demand that could very well overwhelm the system.

Copyright 2013 NPR. To see more, visit http://www.npr.org/.

Transcript

AUDIE CORNISH, HOST:

From NPR News, this is ALL THINGS CONSIDERED. I'm Audie Cornish.

ROBERT SIEGEL, HOST:

I'm Robert Siegel.

And this afternoon, the Obama administration released its much anticipated enrollment numbers for the first month of the troubled Healthcare.gov website. And as predicted, the results were disappointing. Just over 100,000 people managed to choose a health plan between October 1st and November 2nd. And only a quarter of those people, about 27,000, did it through the federal website that's enrolling people in 36 of the states.

NPR's Julie Rovner joins us in the studio now to help put these numbers in some context and talk about the latest on the health care law. Good to see you again, Julie.

JULIE ROVNER, BYLINE: Nice to be here.

SIEGEL: The administration has been talking down these numbers for a while now. Are they about what was expected?

ROVNER: Actually, the numbers for the federal exchange are a bit lower than expected. Earlier this week, people were leaking numbers that suggested the number was about 40,000, so 27,000 is a lot lower than that. On the other hand, what it really tells us is that the Healthcare.gov website wasn't working, so people couldn't get all the way through the process in order to choose a plan. That's not exactly breaking news.

On the state side, we had seen some numbers because some of the states had been reporting right along. The one number we didn't see until just a little while ago was California. It reported that 35,000 people had made it all the way through the process, which is nearly half of the total for the 11 states included in this report.

SIEGEL: Julie, you keep talking about people making it through the process. I want you to explain exactly what the administration is counting in these numbers.

ROVNER: Yes, because that's important. In order to be formally counted as enrolled in a health plan, at least by the insurance company, you actually have to pay the first month's premium. But because no one's insurance they get through the exchange can begin until January 1st of 2014, very few people are going to sign up in October, and then front out money three months in advance.

So the administration is counting what are being called shopping cart people. They are people who have completed the enrollment process and chosen a plan, but not necessarily paid their first month's premium.

SIEGEL: We've also heard a lot about people going to the health exchanges and qualifying for the Medicaid. What do we know about those people?

ROVNER: We know a lot of people are qualifying for Medicaid coverage, or their children are qualifying for the children's health insurance program. Nearly 400,000 people have been deemed eligible for these programs so far; 213,000 in the state exchanges and 183,000 on the federal exchange.

SIEGEL: It's a lot more people qualifying for Medicaid than enrolling in private insurance. Is that surprising?

ROVNER: Not really. Part of it is that in some states there was a big outreach effort to find people eligible for Medicaid or CHIP, and those folks signed up. Also, those systems were working better in October than the private insurance website. It's anticipated that eventually the numbers will even out a little bit more.

SIEGEL: So what do these numbers tell us about the state of the health care law?

ROVNER: Well, really not a heck of a lot other than, as I said at the top, the federal website wasn't working very well in October. Just about every health care analyst points out that you don't expect a lot of people to sign up during the first month of a six month signup period. So the numbers probably would have still been pretty small even if everything had been working just fine.

What this does tell us, however, is that it puts more pressure on the system, particularly on that federal website, as we go forward, particularly if there's a surge of people who want to sign up in time to have insurance that begins January 1st. That means they have to sign up by December 15th. And if that website isn't actually working as promised by the end of this month, or even if it is, there could be a huge demand and it's not at all clear the system is going to be able to serve all those people in that very short period.

SIEGEL: Just to make sure that I understand what you've said here, of the 106,000 people who have signed up for a plan, they have all paid something already to enroll in that plan?

ROVNER: No, they have not. They've signed up. They still have to pay their first premiums - for many of them.

SIEGEL: So that number isn't waiting on people actually paying. That's people who've signed up.

ROVNER: It's some of each.

SIEGEL: And again, the number from the federal Healthcare.gov, 27,000 - a lot lower than anything we'd been expecting.

ROVNER: That's right.

SIEGEL: OK. Thanks, NPR's Julie Rovner.

Thank you. Transcript provided by NPR, Copyright NPR.