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What do Obamacare numbers mean?


The Obama administration released October’s enrollment numbers for on Wednesday afternoon, providing the first official glimpse into the administration’s progress towards implementing the Affordable Care Act. Here is the breakdown:

— 106,185: filled out the application and have selected a plan through a federally run or state run exchange.

79,391: filled out the application and have selected a plan through a state-run exchange.
26,794: filled out the application and have selected a plan through a federal exchange.

— 846,184: filled out the application but have not yet selected a plan

1,509,883: individuals applying for coverage with completed applications
1,081,592: total individuals eligible to enroll in an exchange plan

— 396,261: eligible for Medicaid or CHIP.

— Enrollees by state: California 35,364; Federal exchange 26,794; New York 16,404; Washington 7,091; Kentucky 5,586.

Though the figures fall short of the 500,000 private enrollees the administration had predicted would take-up private coverage before the launch, the numbers come in the midst of highly-publicized technical difficulties with, during which neither the administration nor its allies could deploy a public campaign urging uninsured people to sign-up for coverage.

Ultimately, the numbers provide only a snapshot into a six-month long enrollment process.

Administration officials have for weeks tampered down expectations, arguing that website issues may have led some enrollees – particularly the younger and healthier population who does not absolutely need coverage – to put off enrollment. They insist that the website will be operational for the vast majority of users by the end of the month and predict that the uninsured will be able to successfully enroll in insurance by Dec. 15 for coverage that begins on Jan 1.

Some of that optimism is informed by past enrollment experiences, in which people waited until the last minute before enrolling in coverage. Officials point to the fact that just 123 people enrolled in Commonwealth Care – the Massachusetts health care exchange for subsidized care – during its first month in February of 2007 and after the first four months, just 15,560 of an estimated 80,000 uninsured who qualified for coverage signed up.

Enrollment didn’t spike until December of 2007. Enrollees also preferred to window shop, making an average of 18 different contacts with the website, call centers and other sources provided by the state” before ultimately settling on a plan.

“Enrollment in new programs begins slowly and often takes several months to build momentum,” said Avalere CEO Dan Mendelson, whose firm has independently tracked enrollment. Indeed, The Children’s Health Insurance Program (CHIP) and President George W. Bush’s Medicare Part D experienced this very same enrollment pattern. CHIP, a bipartisan Clinton-era initiative that primarily provides health insurance to children in families with incomes too high to qualify for Medicaid, initially fell far short of enrollment goals.

Similarly, more than half of the seniors who signed up for Medicare Part D didn’t do so until after the initial enrollment period and enrolled despite the Bush administration’s well-publicized initial glitches in extending coverage to low-income beneficiaries.

The Congressional Budget Office estimates that 7 million enrollees will participate in the marketplaces in 2014; 9 million will sign up for Medicaid. By 2023, the exchanges will hold 24 million people and the law’s Medicaid expansion will accompany another 13 million.

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