Today the Department of Health and Human Services released a new issue brief detailing enrollments in the Affordable Care Act, otherwise known as Obamacare, through April 18. A summary of those numbers can be seen here. The biggest number is 8,019,863, which is the total number people enrolled in Marketplace plans through state-based and federal exchange. That number exceed the 7 million enrollment goal the Obama administration set for itself at the beginning of the open enrollment period on October 1. There was a particular surge in enrollment in March, when a total of 3.8 million signed up for coverage which was a 90 percent growth rate over February's numbers. Of the 8 million who enrolled, the insurance companies report that approximately 80 to 90 percent have paid their first premium. Here is a closer breakdown of the enrollment numbers using the HHS full issue brief, which can be read here.
Of the 8 million total enrollments, 2.2 million (28 percent) consisted of people between the ages of 18 and 34. This demographic is seen as key to keeping premiums low in the exchanges. The 28 percent number falls short of the administration's goal of 40 percent, but is still seen as high enough to keep premiums from rising at a high rate next year. Nearly 1.2 million (over half) of the 18-34 year-old's who enrolled waited until the last month of to enroll.
When choosing a insurance individuals had a choice between bronze, silver, gold, and platinum level plans. Bronze is the lowest level of coverage with higher deductibles, copays, etc. The administration was hoping more individuals would select silver-level plans, or higher, and their hopes seem to have been confirmed. Of the 8 million who enrolled, just 20 percent selected a bronze plan, compared to 65 percent a silver plan, 9 percent a gold plan, and 5 percent a platinum plan.
Approximately 85 percent of those who selected a plan received some form of financial assistance to do so. People who received financial assistance were, not surprisingly, more likely to purchase a silver level plan or higher.
The state with the biggest enrollment number was California with 1,405,102 enrolled. That number is hardly a surprise since California has the biggest population, by far, of any state in America. Some surprises were Florida (983,775) and Texas (733,757) which put up good enrollment numbers despite having state governments which did not support Medicaid expansion and the Affordable Care Act in general. In contrast, New York, which has a population roughly equal to those two states, had only 370,451 enrollments.
States with disappointing enrollment totals, when placed next to states with comparable populations, include Minnesota (48,495), New Jersey (161,775), Oregon (68,308), and Ohio (154,668). Minnesota and Oregon had state-based exchanges, and both have had a rough time in their first year. Oregon, in particular, has been a state-run disaster story in the first ACA open enrollment and the federal government is now set to take over that system.
Some other notable states with impressive totals included Georgia (316,543), North Carolina (357,584), and Virginia (216.356). All three of those states actually had federally run marketplaces.
There was a very wide variation in the enrollment numbers by state. The difference in success from state-to-state will make for an interesting study in the coming months. Some failures (Oregon) are easy to explain, as are some successes (Kentucky). Others, see Ohio's relative failure and North Carolina's relative success, are less obvious.
The overall enrollment numbers are more than acceptable for the ACA's first year, and the internal numbers are at least sustainable when it comes to age, metal level, etc. After some early stumbles, Obamacare now appears to be taking some key first steps in the marathon that will ultimately determine its fate.