— HealthCare.gov (@HealthCareGov) April 1, 2014
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.
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.
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.