ACA Round Two: A Look at the Numbers

Feb. 25, 2015

Topics: Health Care Reform, Exchanges, Access to Care

by Joe Infantino, staff writer

Ultimately, the Affordable Care Act's second open enrollment period will be evaluated by several metrics, including lowering the uninsured rate, decreasing the cost of care and providing a smooth sign-up process.

By the most basic measure -- total sign-ups -- the second open enrollment period was a success, at least by the Obama administration's standards.

"While the administration is going to say it was a success no matter what, we are actually on track to enroll enough people to create a stable market," Caroline Pearson, vice president of Avalere Health, said.

In November 2014, HHS predicted that between 9.1 million and 9.9 million people would be enrolled in coverage this year. By Jan. 16, with a month left to sign up, 9.5 million individuals already had selected a health plan through the federal and state exchanges. Two weeks later, total enrollment neared 10 million -- 7.5 million sign-ups through HealthCare.gov and almost 2.4 million through the state-run exchanges.

Since then, the number of sign-ups continued to increase, punctuated with a final-week surge, settling at about 11.4 million by the initial Feb. 15 deadline, with about 8.7 million through the federal exchange.

HealthCare.gov Signups

While the numbers don't reflect how many consumers have paid their first premiums, effectively finishing the enrollment process, HHS is well on its way to surpassing its enrollment goals. The numbers are likely to continue to rise over the next few weeks, as several state exchanges and the federal exchange have granted enrollment period extensions.

Accomplishment or Lowball?

Pearson expressed a sentiment that many other experts echoed. She said, "The actual question is whether 9.1 [million] was any sort of meaningful accomplishment," adding, "I would say it was a lowball."

The notion that the Obama administration was lowballing comes because HHS' estimate was far lower than the Congressional Budget Office's initial estimate for the second open enrollment period. CBO said about 13 million people would have exchange coverage in 2015.

Regardless if HHS intentionally set the bar low, there is still good news for enrollment. All 37 states using the federal exchange outpaced their first-round performance (even accounting for last year's inflated enrollment numbers).

Florida, for the second-consecutive year, stood out as the top-performing state. Last year, about 983,775 Florida residents enrolled in coverage (including dental plans). By Feb. 15, Florida's plan selections exceeded last year's enrollment by more than half a million, with 1,600,006 new sign-ups and re-enrollments (excluding dental plans).

Texas followed Florida in enrollment in both 2014 and 2015. During the ACA's first round, about 733,757 Texas residents enrolled (counting dental plans). By Feb. 15, more than 1,189,316 Texas residents selected a plan (excluding dental plans).

Even the lower-performing states significantly increased their numbers.

Wyoming, which enrolled approximately 11,970 residents in the first open enrollment period, signed up 21,148 by Feb. 15. Meanwhile, Alaska, which enrolled 12,890 residents in the initial enrollment period, singed up 20,897 by Feb. 15.

HealthCare.gov Plan Selections 

Flexible Enrollment Process

In addition to HHS surpassing its goal and better individual state performance, another storyline of success this year has been a smoother, more adaptive enrollment process for consumers -- one that lacked any major technical issues with the exchange websites. That is, until the very end.

HealthCare.gov users during the first few days of the second enrollment period reported only minor technical issues, such as problems with verifying their identity via the site's identity proofing process.

But by and large, HealthCare.gov functioned at a faster pace than it did last year. The website was bolstered by a new system for better detecting site traffic overloads, which seems to have worked, as there were no reports of a crash during surge in sign-ups leading up to the Dec. 15, 2014, deadline for coverage that started Jan. 1.

"When problems came up, [the administration was] very responsive in trying to figure out what the problem is and fix it," said Tim Jost, a professor at Washington & Lee University's School of Law.

However, one day before this year's closing deadline, some consumers reported problems with submitting applications for coverage. An HHS statement said that the errors occurred "because their income [was] unable to be verified as a result of intermittent issues with external verification sources."

The issue was resolved that same day. As a result, HHS granted consumers trying to sign up for coverage that weekend an "in-line-by-midnight" extension, under which consumers who started their applications by Sunday's midnight deadline would be eligible complete the sign-up process through Feb. 22.

Targeted Outreach

Meanwhile, the administration this time around also stepped up its efforts to enroll special populations, such as young adults and Latinos.

For example, the administration and several not-for-profit groups launched an outreach initiative using ads and Spanish-speaking assisters to ease some Latino residents' fears that enrolling in health plans would place undocumented family members at risk of being deported. The administration also emphasized that it improved the functionality of its Spanish-language version of HealthCare.gov.

Reviews of the administration's efforts are mixed.

Alicia Wilson, executive director of La Clinica del Pueblo, a Washington, D.C., health center that provides services to Latino communities, told PBS News Hour, "The federal government can proclaim every day ... how immigration information in the exchange is not going to be used for deportation proceedings, but it's still really scary" for them.

Plan selections among Latinos did increase, even if incrementally. Last year, about 7% of consumers who signed up were Latino. By Jan. 16 this year, about 10% -- or 471,051 -- were Latino.

Plan Selections by Race 

Some have called the three-percentage-point increase insignificant, considering the ACA's media budget for Latino-outreach more than tripled from last year.

Others think it's just a work in progress. "It's something that will continue to build," Jost said.

Meanwhile, the federal exchange by Jan. 16 had signed up 1,362,348 individuals age 25 and younger.

Pearson said that means "there is a long way to go in terms of balancing the demographics of the population." However, she added, "But I think we can say it’s going to be a success."

Plan Selection By Age


State-Run Exchanges

Meanwhile, although data from the state-run exchanges was inconsistent, HHS ultimately released figures showing that as of Jan. 17, nearly 2.4 million individuals selected plans through state exchanges. By Feb. 15, that number increased to about 2.7 million. Several states have since granted their residents extensions and total enrollment should settle slightly higher.

Here’s a rundown of how the state-run exchanges have done:

  • California: As of Feb. 12, more than 354,000 new consumers selected a private health plan through Covered California, bring total enrollment to about 1.36 million. However, prior to the Feb. 15 deadline, California granted an extension to Feb. 22 for those who started but were not able to complete their application by the initial deadline.
  • Colorado: By Jan. 31, more than 186,497 residents signed up for private coverage. Connect for Health Colorado also granted an extension to those who had started but not yet finished their applications by Feb. 15.
  • Connecticut: As of Jan. 17, about 91,139 residents had selected a plan through Access Health CT.
  • D.C.: By Feb. 13, 20,358 individuals signed up for private coverage through DC Health Link. Consumers who experienced problems completing their applications were given through Feb. 17 to complete the sign-up process.
  • Hawaii: About 6,868 residents signed up for coverage through Hawaii Health Connector as of Jan. 17.
  • Idaho: By Jan. 17, 90,567 residents signed up for coverage through Your Health Idaho.
  • Kentucky: As of Jan. 17, 93,677 residents had signed up for coverage through KYnect.
  • Maryland: By the Feb. 15 deadline, about 250,000 residents had signed up for coverage through Maryland Health Connection. However, the exchange granted an extension through Feb. 28 for consumers who experienced problems completing their applications by the initial deadline.
  • Massachusetts: As of Feb. 12, about 125,651 residents signed up for coverage through Massachusetts Health Connector. Due to severe weather in the state leading up to Feb. 15, the exchange extended its enrollment period through Feb. 23.
  • Minnesota: By Feb. 12, 49,238 residents signed up for coverage through MNsure.
  • New York: As of Feb. 4, about 512,968 residents were signed up for coverage, of which about 132,549 were new enrollees. NY State of Health announced that consumers who started but were not able to complete their application by Feb. 15 would have through Feb. 28 to sign up for coverage that will start April 1.
  • Rhode Island: By Feb. 7, about 28,787 residents selected a health plan through Health Source RI. Meanwhile, the exchange granted consumers who started but were not able to complete their application a special enrollment period through Feb. 23.
  • Vermont: By Feb. 9, about 4,786 residents had selected a private health plan.
  • Washington: As of Feb. 11, about 139,000 individuals selected a private health plan through the Washington Health Benefit Exchange. Washington state extended its enrollment period by two months, until April 17, for those who have not yet signed up.