And we’re done

 

Regular open enrollment in all areas of the continental United States for Exchange coverage is done. And the numbers are massive. I was guessing 6.5 to 7.0 million by this date in January. I was wrong. It looks like total enrollment excluding the people who checked the little blue box for an extra two weeks will be over 7.0 million people.

USA Today has some details:

Late Monday, a government official told USA TODAY that the administration is on track to sign up 7 million people by the midnight deadline. The official spoke on condition of anonymity because officials were not authorized to speak before the enrollees were all counted.

It is likely to be weeks before there is a final, official tally of how many people signed up for insurance under President Obama’s signature Affordable Care Act as the administration has said will continue to work with late arriving applicants to get them covered.

Let’s make some predictions about the newest cohort of enrollees.

  • Healthier than the February cohort and much healthier than the October/November/December cohorts

If we assume the Exchange market is similar to any other health insurance open enrollment market, the people who know that they need coverage because they are either sick, have a long term condition needing care or believe that they are higher than typical risk of getting sick, signed up first.  They’ve already invested the mental energy to determine that they are getting a good deal.  The people who have not signed up until the deadline are healthier than the early sign-ups.

  • Younger

This ties to being healthier, but it is somewhat independent of health.  Health insurance is a lower salience issue on average for young people when compared to old farts who know that they could start breaking down.

  • Less connected to previous systems of aid

There were mass conversions of state-run programs to Medicaid expansion.  There were deliberate outreach efforts for individuals with long-term care needs who were receiving frequent charity care.  People who were on the fringes of the American healthcare system but inside the fuzzy boundaries were some of the easier lower hanging fruit to enroll.  People who were just outside the fuzzy lines were harder to enroll with limited resources.

So what does this mean for 2015?

The actuaries will be drinking way too much coffee for the next month as they try to figure out what next year’s rate structure should look like.  Remember, the CBO projects twice as many people to be on the Exchange next year as they projected for this year.  That population will be a bit different in key ways from the 2014 Exchange enrolled population.  However, 7 million or more people on Exchange, and 9 million people with off-Exchange but PPACA compliant shared risk pool policies means there is some good data to make some decent guesses for next year.

 

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24 replies
  1. 1
    karen says:

    There were mass conversions of state-run programs to Medicaid expansion. There were deliberate outreach efforts for individuals with long-term care needs who were receiving frequent charity care. People who were on the fringes of the American healthcare system but inside the fuzzy boundaries were some of the easier lower hanging fruit to enroll. People who were just outside the fuzzy lines were harder to enroll with limited resources.

    That would be me. Lost my job in May and I’m in the beginning stage of my second consideration for disability. Because I’m getting no income because my unemployment ran out, that made me eligible for MD Medicaid and let me tell you, it’s almost as good as regular insurance.

  2. 2
    David M says:

    Excellent update, always interesting to hear the actuarial details that aren’t in the USA Today article.

  3. 3
    catdevotee says:

    I’m happy to report that my 26 y/o son now has insurance! He finished college, then has had a series of jobs which didn’t offer any insurance, so naturally I’ve been a little worried (worrying is a mom’s job, right?)… I’m relieved that paying for a medical emergency won’t be a problem now. He chose a high deductible policy, so the payments are quite affordable even though he’s not eligible for a subsidy.

  4. 4
    andy says:

    Obviously, this is good news for John McCain.

  5. 5
    OzarkHillbilly says:

    Woohoo!

  6. 6
    David M says:

    Seems like a good time to remind everyone that Jonathan Adler (and the rest of the GOP by extension) is doing everything he can to make sure that approximately 4 million of these people are not able to receive the credits for buying health insurance on the exchange. Just in case anyone thought of the Volokh Conspiracy as anything but a group of Republican sociopaths.

  7. 7
    raven says:

    Joe and Halperin are stunned that it has gone so well.

    eta Ah cool, whining about the website!!!!

  8. 8
    Alex S. says:

    Oh, human nature…. always waiting until the last day…

  9. 9
    PurpleGirl says:

    Richard — yesterday I had a doctor’s appointment at the clinic I go to at a NYC hospital. They usually have a number of tables with people helping to fill out application for the various Medicaid and state-supported insurance operations (HealthFirst, etc.). Yesterday the lobby space of the clinic building was FULL of people lining up to talk to counselors. The lines jumped several hallway openings and the cashiers windows. The hospital administration was expecting some increased traffic but not as many as they had.

    I would estimate that half to two-thirds of the line were families of lower-wage workers who are immigrants. They also a table or two on another floor, which had a line.

  10. 10
    Chyron HR says:

    “My fellow Americans, it’s been an amazing process passing this revolutionary bill, implementing subsidies and Medicaid expansions, and signing up over seven million uninsured people for health insurance policies. And now, as your President, it gives me great pleasure to announce: April Fools.”

  11. 11
    Joe F says:

    The Repub Governers have helped the National party remain strong, but their decision to forgo Medicaid $ may actually backfire on the Party as a whole. I suspect there will be many charts showing the Insured rate skyrocketing in the States that bought in and flatlining in those that declined. This will graphically demonstrate that the ACA achieved its main goal, but not in Red States and will dramatcally show Red reticence negatively impacted its citizens. The Dems should not run from ACA, they should continually pound stats that show how it met its main objective of increasing the number of Insureds. The delta between Red and Blue will be substantial.

  12. 12
    Thoughtful David says:

    Even The Liberal Washington Post this morning has on its front page a story about the signups yesterday, with the headline–wait for it….”Healthcare.gov hiccups on last day frenzy.” I think the real story yesterday was that 3 million people were on the web site by 8 pm (about the time they would have been putting the WaPo to bed), but where was that story? Huh?
    Well, I guess you go to being a third-world status country with the MSM you have, not the MSM you wish you had.

  13. 13
    JGabriel says:

    Richard:

    I don’t know if I’ve commented very much or not in your posts (it’s not an area where I have a lot to add), but I’ve read most or all of them — and now that the first enrollment period is over I just wanted to say thanks for all the work, information, and analysis you’ve shared with us over the past months.

    Thanks!

  14. 14
    amk says:

    @Thoughtful David: Obama’s katrina, man. It never ends.

  15. 15
    satby says:

    I second what JGabriel said: your posts were always informative and personally helpful to me. Much appreciation!

    And I wonder if when Rs try to discount the numbers of newly insured by saying that lots of us had insurance before they account for all of us who got laid off (and continue to get laid off, my former company just cut another several hundred employees last Friday) and lost our previous insurance. When that metric is counted do they go by unemployment statistics?

  16. 16
    EconWatcher says:

    I think this will help if and when the Jonathan Adler issue gets to the Supreme Court. If the law has actually been implemented and many millions of people are relying on a settled interpretation, the Court will be less likely to upset it.

    That kind of factor may not influence Scalia, but I think it would influence Roberts.

  17. 17
    SarahT says:

    Thirded what JGabriel & Satby said. Thank you for always explaining this stuff in plain language. It really helped.

  18. 18
    Fred Fnord says:

    @Joe F:

    This will graphically demonstrate that the ACA achieved its main goal, but not in Red States and will dramatcally show Red reticence negatively impacted its citizens.

    On the contrary, ‘those people’ not getting coverage is something to celebrate in many states.

  19. 19
    MomSense says:

    Yes, thanks Richard! We are probably the best informed jackals on the intertubes about all things ACA!

  20. 20
    Mnemosyne says:

    California did great at signing people up all along, but we extended the final deadline to April 15th to get to all of the procrastinators. Very proud of my adopted home state right now: we may be a dysfunctional family sometimes, but when we decide to function, we can goddamn function.

  21. 21
    JustRuss says:

    Cue the conservative crying about how Obama “cheated” by extending the deadline two weeks in order to boost the ACAs numbers. Because it’s all a fucking game to them, and people getting healthcare, or not, is just a metric for keeping score. And the horserace loving MSM will lap it up.

    What, too cynical?

  22. 22
    Fair Economist says:

    I appreciate your work keeping us updated, especially given you must be as swamped as anybody in this last-minute rush.

  23. 23
    Fair Economist says:

    @Fred Fnord:

    This will graphically demonstrate that the ACA achieved its main goal, but not in Red States and will dramatcally show Red reticence negatively impacted its citizens.

    On the contrary, ‘those people’ not getting coverage is something to celebrate in many states.

    For some, but not a governing majority. The last-minute success of the first open enrollment shows what a huge catastrophe the Republican intransigence risks. If next year follows predictions like this year did in the end, then we’re going to be to the “everybody knows somebody who has and needs Obamacare” stage. But they’ll still be wedded to ‘repeal Obamacare at all costs’. At that point a working majority of voters will conclude that whatever the faults of the Democrats, you just have to keep the Republicans out of power.

    That’s kind of how it works in California. I don’t know too many die-hard Democrats. But I know lots and lots who think the Republicans are nuts and who will put up with a fair amount of corruption and gun-running by Democrats. There’s just no choice.

  24. 24
    Richard Mayhew says:

    @Fair Economist: Thank you to everyone — I’ve enjoyed this… but honestly, the nature of my job and responsibilities means I have to be aware of what is going on now, but most of my work is focused on 2015 and 2016 implementation. My 2014 implementation work was 93% done last November. The enrollment, sales and customer service teams are the ones who were riding the open enrollment roller coaster, not me.

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