The grand fanfare and jubilation leading up to the unveiling of state and federal healthcare insurance exchanges last October quickly came to an end when the HealthCare.gov website, for all intents and purposes, failed to launch. And when the first day enrollment numbers trickled in and was learned that only six individuals had sign up for a healthcare insurance, the nation became aware of how very very broken the website really was.
Staff members at HHS were gravely concerned with the technical difficulties the HealthCare.gov website was having but knew that in time they would be overcome. Their greater concern was with the fact that of the large number who did manage to enter the HealthCare.gov website, only six had enrolled over the first 24 hours. This had HHS and the entire White House very worried!
The technical issues that plagued the HealthCare.gov website would eventually be ironed out and as the website’s performance improved, it became more and more apparent that attracting new customers would be the greater challenge facing the controversial healthcare law.
Fearing backlash from those who strongly opposed ObamaCare, the game of hide and deceive began. The numbers game has been so masterfully played by the Obama Administration that to this day it remains uncertain as to exactly how many of America’s uninsured actually obtained healthcare coverage yet most people are under the impression that all the cards have been laid on the table and enrollment met its goals. Enrollment figures for the 2014 enrollment period do in fact exist however, the administration has made the conscious decision to withhold this information from the American people who are paying for this mess!
Enrollment Goals
Heading in to the 2014 open enrollment period, HHS had set three enrollment goals.
The most publicized of those goals was the number of uninsured individual projected to purchase a qualified healthcare plan (QHP) from one of the state and federal healthcare exchanges. In the months leading up to the start of the initial open enrollment period HHS regularly stated the enrollment goal of 7 million, a figure that was adopted from an analysis performed by the Congressional Budget Office (CBO). It is important to qualify this number as it has been widely misused by the Obama Administration in claiming success during the first open enrollment period, which we will get to later. For now, what we need to understand about the CBO projection is that it represents only the uninsured nonelderly.
The second and less publicized goal was the percentage of young and healthy, commonly referred to as “the millennials”, projected to purchase a QHP. HHS anticipated that between 38-40% of all enrollments would come from millennials, a critical goal that had to be met in order to balance the risk between insuring the young and the old. Under the payment structure put forth by ObamaCare, the young, while costing far less to keep healthy, pay more for their insurance. This was done to offset the lower cost of insurance provided to the elderly, many of whom are on a fixed income but cost more to keep healthy.
Last is the goal set for the Medicaid/CHIP expansion which was projected to come in at 8 million by the CBO.
These primary ObamaCare enrollment goals were not just targets the administration wished to achieve, they were goals that were vital to meet so as to ensure the fiscal well-being of the law. Falling short of any of these goals would have both fiscal and political ramifications as we are now learning.
Ten Million Gained Health Coverage
It took them awhile but four months after the 2014 enrollment closed HHS announced, in a press release , that a new study published by the New England Journal of Medicine ‘estimated’ that 10.3 million uninsured adults gained health coverage during the Marketplace’s first annual open enrollment period.
The 10.3 million figure, which now has been adopted by the administration, actually originates from a long term study being conducted by Gallup-Healthways Well-Being. Two other well-known and trusted sources, the Urban Institute and the RAND Corp. have also conducted similar studies which estimate the number to have gained health coverage over the initial enrollment period to be 8.0 million and 9.3 million respectively.
It is important to qualify the figures reported in the above mentioned studies. In all three cases the studies capture both those who have gained insurance through the purchase of a QHP and those who have taken advantage of the Medicaid expansion and have reported them as one number. HHS on the other hand tracks QHP and Medicaid/CHIP enrollment separately.
Here is where the waters get murky. HHS, having adopted the Gallup findings to portray enrollment success, they do so without qualifying the number thus misleading many in to believing that 10.3 million QHPs have been sold on the exchanges. Whether the administration does this intentionally or not we will leave for you to decide.
So why does the Gallup study get top billing over the other studies? The obvious reason would be that their estimates place ObamaCare enrollment in the best light. A more important question to ask is why HHS does not use its own enrollment count verses and estimate drawn from an independent study? Chances are the same answer applies!
So for now, we are working with the 10.3 million figure adopted by HHS, we just need to break it down, which we will do in a moment.
Effects of the Medicaid Expansion
On May 1, 2014 the Centers for Medicare and Medicaid Services (CMS) released a factsheet which reported that more than 5.8 million additional individuals enrolled for Medicaid and CHIP during the initial ObamaCare open enrollment period. This figure is not a reflection of the success or failure of the Medicaid expansion and is only being mentioned as it will be needed in just another moment when we take a closer look at what actually happened with QHPs purchased on the state and federal healthcare exchanges.
By the end of September, 9.1 million had enrolled for Medicaid/CHIP, already exceeding the administrations 2014 goal of 8 million. It is anticipated that at least 1 million more will enroll for Medicaid/CHIP before the close of 2014, pushing the number of those taking advantage of the Medicaid expansion over 10 million.
Exceeding the Medicaid enrollment expectations is not necessarily good news for taxpayers as the transitional federal assistance will soon be gone and each expansion state will have to make additional budgetary adjustments to accommodate the unexpected higher number of participants.
Woodworkers, those who were qualified for Medicaid prior to the expansion but did not enroll until the ObamaCare rollout, have also exceeded predictions and will too need to be accommodated for in states budgets.
Enrollment Confusion on the Exchanges
If you like your plan you do not necessarily get to keep your plan was the lesson millions learned as we heading in to the fist open enrollment period. And while a political battle raged around a near mortally wounded HealthCare.gov website, more and more of those who had their insurance policies canceled began to purchase new policies via a website that was being held together with bailing wire and duct tape.
At the halfway point, HHS reported that an estimated 2 million had signed up for a QHP, leaving a lot of ground to cover in order to reach their 7 million target. However, as the inaugural sign up period approached the finish line, enrollment improved significantly and at the closing bell looked to have reached just over 8 million. The speculation is that cancelations were becoming affective and drove a swarm of those affected to the exchanges.
With ObamaCare proponents celebrating their faux success, the opposition was crying foul as, by all indications, a very large percentage of the QHPs sold on the exchanges were purchased by those who had their policies canceled. Skeptics also called in to question the number of the claimed 8 million enrollees that had actually finalized their transaction by providing payment to the insurer.
As it turns out, at least 1 million who selected a QHP on one of the exchanges ended up not paying for their plan. Adding insult to enrollment injury, congressional oversight recently discovered that HHS had counted some 400,000 dental only plans as complete enrollments. This prompted HHS to revise down their enrollment figure, for the fourth time, to 6.7 million.
Policies Were Canceled
It is hard to put a finger on exactly how many policies were canceled for not being ACA complaint but the number is well into the millions.
The Urban Institute, a Washington DC-based left leaning think tank, puts the number of canceled policies to be as low as 2.6 million. On the other side of the spectrum, the Rand Corp, a left to center global policy think tank speculates that cancelations could be as high as 4.7 million. And these are policies, not individuals these studies are speaking of so the number of individuals who lost coverage through cancelation could be staggering.
It is hard to fathom that HHS does not have a good estimate as to how many individuals were affected by the cancelations just as it is hard to imagine they also do not know how many QHPs were purchased by them. If they do in fact know, they are being very tight lipped about it.
How Many Long Term Uninsured Actually Purchase a QHP?
The Obama Administration has been deliberate in its intentions to withhold enrollment figures, likely in an effort to prevent the political firestorm that would ensue by an admission of failure. But HHS has laid claim to enough pieces of the enrollment puzzle that a reasonable picture can be painted.
If you were to take away the 5.8 million Medicaid enrollees from the 10.3 million reduction of the uninsured, the figure adopted by HHS, you would arrive at 4.5 of the 6.7 million QHPs purchased during the open enrollment period belonging to the formerly uninsured. Possible sure, but unlikely as this leaves only 2.2 million enrollments transpiring from the 2.6 to 4.7 million canceled policies.
A more believable scenario would be to use the Urban Institute’s 8 million estimate in the reduction of the uninsured. Doing so, you would arrive at 2.2 million QHPs purchased by the formerly uninsured once the 5.8 million Medicaid expansion enrollees are backed out. This better accounts for the number of those who lost their healthcare plan and subsequently purchased a QHP from one of the exchanges but speaks very poorly of ObamaCare’s ability to attract the uninsured.
Without actual figures provided by HHS, these educated speculations are as good as it gets. Neither plays well as a measure of success for the ObamaCare law and yet, the administration has done nothing in helping us to draw a better conclusion.
In Conclusion
If it remains the goal of the Obama Administration to convince 25 million uninsured nonelderly to purchase a qualified healthcare plan by 2017, we can go ahead and call the game now. As it stands, fewer than 10 million in the target group are likely purchase a QHP by 2017 leaving 39 million remaining uninsured and this is being optimistic.
There appears to be little interest on the part of the uninsured to purchase healthcare insurance even under federal mandate. Reasons for this could be complex or maybe as simple a misguided belief that the product is so good that people would be fighting to sign up.
Whatever the case, no amount of touting misleading numbers and overstating the success of the unpopular healthcare law will be able to save ObamaCare in the end. With a price tag well in excess of $2 trillion over the next decade, those footing the bill are going to demand that the healthcare law deliver as promised or will call for its repeal.
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