March 31, 2014 marked the end (almost) of the first open enrollment period under the Affordable Care Act. And the unofficial numbers are in: 7.1 million people signed up for insurance through a health insurance exchange and there are an additional 3 million enrolled in Medicaid.
Is this a success or a failure? It’s somewhere in the middle. What it really marks is the beginning of a long climb. But let’s dive in a bit more.
On the success side, there are some clear wins:
- The exchange number exceeds the original first year enrollment estimate of 7 million.1
- The numbers may increase, since “the ballots are still being counted.” Several states are still open for enrollment until April 15, and the federal exchange is allowing anyone who started the process by March 31 but ran into difficulties, to enroll until April 15.
But there are also challenges:
- Some people won’t end up paying their premiums, so we can expect the enrollment numbers to decrease. According to Secretary Sebelius, the current estimate from insurers is that 80-90% of enrollees have made their first payments.
- This level of enrollment may not be enough for exchanges to be financially self-sufficient by 2015.
WHAT SHOULD WE BE MEASURING?
From a public policy perspective, the key question is: did the number of uninsured people decrease? The federal government isn’t officially tracking how many exchange enrollees were previously uninsured, so we have to rely on survey data. A McKinsey survey from February 2014 reports that only 27% of those who signed up through exchanges were previously uninsured, and a more recent RAND study reports that about one-third were previously uninsured.
But there are some recently released national surveys that report that the number of uninsured has decreased by several percentage points (from 20.5 to 15.8% or from 17.9 to 15.2%, depending on the survey).2 These surveys capture the whole picture: those who are newly insured through exchange enrollments and Medicaid, and those who lost insurance coverage (employer sponsored insurance or otherwise). And the surveys don’t yet capture the exchange enrollment surge in March.
There are other important things to measure, including affordability and the make-up of the covered population: How many young people? How many sick? And how many need subsidies? We’ll take a look at this in future blogs.
Health reform will take years to fully implement. This ramp-up period will last for at least three years. Exchanges are expected to cover up to 25 million by 2016.
Reaching these numbers will be challenging. For starters, the 2015 open enrollment period will be shorter than this one was (three months instead of six months).
Exchanges and their insurer partners will have to make the best of this tighter timeframe by optimizing their “actionable advertising” and outreach. But they can certainly benefit from the lessons learned in the first open enrollment period.
2. The survey released by the Robert Wood Johnson Foundation suggests the number of uninsured has decreased from 17.9% to 15.2%, while the RAND study states that the number of uninsured has decreased from 20.5% to 15.8%.