Healthcare Exchange Enrollment Far Worse than Previously Reported

It has been just over two years since the opening of the healthcare Marketplace and yet we still do not know definitively how many people have purchased a healthcare plan through the state and federal healthcare exchanges.
After an abysmal turnout by the uninsured during the first open enrollment period, the Obama Administration completely locked down the Department of Health and Human Services (HHS) from releasing detailed enrollment data, particularly anything pertaining to the number of uninsured that purchased a qualified healthcare plan through the state and federal healthcare exchanges. 

The Obama Administration had three years and spent nearly $1 billion taxpayer dollars to enlightening us all on the wonders of ObamaCare.  And as the opening day neared it was the President himself who repeatedly touting what a great success the individual mandate was going to be in bringing affordable healthcare to the 28 million uninsured individual who qualified to participated on the healthcare Marketplace.  And yet, so few showed that the administration was embarrassed to make public the enrollment figure.

The first open enrollment period was supposed to be the biggie with the millions of individuals who had been denied access to healthcare insurance due to a pre-existing condition knocking down the doors to sign up, along with others who the administration claimed always wanted healthcare insurance but were simply priced out of the marketplace.  As it turns out, only a handful of those thought to be at the front of the line on opening day ever turned out during the inaugural 6 month long open enrollment period.  Best estimates at the time were that just over 1 million of the 8.1 million who purchased a healthcare plan through the exchanges came from the pool of 28 million uninsured.  The balance was made up of individuals who had their non-ACA compliant plans canceled and re-insured themselves through the exchanges.  The Obama Administration never put an official head count to the number of uninsured who purchased and maintained a healthcare plan during the open enrollment period and they liked it that way.

The second open enrollment period fared no better than the first and the Obama Administration remained just as tight lipped to the number of the nations uninsured that purchased a healthcare plan through the exchanges.  And while they made no mention of this failure, the administration was constantly patting itself on the back for its success in enrolling millions on to taxpayer funded Medicaid as a result of the program’s expansion.

At the close of the second open enrollment period, best estimates at the time were that as many as 4 million of the nations uninsured might now have obtained healthcare insurance through the exchanges.  However, as more information became available, that number slowly dwindled to as few as three million.  It should also be noted that at the time ObamaCare was passed in to law, the administrations original enrollment goal for the close of the second open enrollment period was to have insured 10 million of our nation’s uninsured through the state and federal healthcare exchanges.


Drilling Down on Enrollment

Two reports recently released by the HHS together have helped to shed new light on enrollment of the uninsured through the healthcare exchanges.   

First is the ASPE Date Point Report.  Released this past September, from this report we can see that HHS has adopted the figure of 15.3 million as the number of people they are claiming to have gained healthcare coverage since the beginning of open enrollment back in October of 2013.  I say adopted as this is not a figure generated by HHS but instead one provided through an independent survey conducted by Gallup-Healthway Well-Being. 

The 15.3 million figure reported by Gallup-Healthway and adopted by HHS is reflective of all who have gained some form of healthcare coverage, since open enrollment first began, regardless of source.  In other words, amongst the 15.3 million are all those who are now covered through the Medicaid Expansion; those who purchased a healthcare plan on the private marketplace; those who are now insured through their employer and of course those who obtained healthcare coverage through the state and federal exchanges.
 
Just to be sure we are clear, this 15.3 million enrollment figure includes the entire universe of people that have gained some form of healthcare coverage since open enrollment started.  Also, this third party generated figure, adopted by HHS, is not based on an actual count and there is nothing that leads us to believe that HHS has validated it in any way.

If it strikes you as odd that HHS does not use their own enrollment count, it should as they most certainly have the resources to do so.

Second we have the CMS MedicaidEnrollment Report.  CMS publishes Medicaid enrollment updates monthly, this particular report being the latest release and represent enrollment through July of this year.  In the report we find that CMS has reported a figure of 13.2 million individual have taken advantage of the Medicaid expansion through July of this year.  Unlike the previous report, Medicaid enrollment is an actual count compiled internally by CMS so they own this. 

We will use the Medicaid enrollment figure to help us determine enrollment through the healthcare exchanges but first I am going to take the liberty of bumping it up by 200,000 to make it more representative of what enrollment looked like in September thus matching the same time period of the previously discussed ASPE report.  Bump the Medicaid enrollment figure to 13.4 million errors well on the side of caution, falling well below the average increase in Medicaid enrollment for the past three reported months.


Drum Roll Please

If we were to assume that since January 1, 2014 no uninsured person eligible to participate on the healthcare Marketplace became insured through their employer or an off-exchange insurer, then by removing the number of individuals who have taken advantage of the Medicaid Expansion (13.4 million) from the total reduction of the uninsured since open enrollment began (15.3 million) we would arrive at the number of individuals who have obtained healthcare insurance through the state and federal exchanges.  Under these assumptions, 1.9 million people obtained healthcare insurance through the state and federal healthcare exchages.

Out of the pool of 28 million uninsured who are qualified to participate on the ObamaCare created healthcare Marketplace, no more than 1.9 million have done so over the course of two open enrollment periods.  That does not speak will for the healthcare law that was intended to bring these 28 million people access to affordable healthcare.  1.9 million is also significantly less that previous projections and is less than 20% of the administration targeted enrollment for 2015, as originally forecasted by the CBO and used to sell ObamaCare.  This is also in no way, shape or form what was promised to the American people when congressional Democrats and the President jammed this law down our throats.

And 1.9 million still does not represent the number of people who actually purchased a healthcare plan through the state and federal healthcare exchanges as it still includes those who gained healthcare insurance through their employer and those individuals who purchased healthcare insurance through a private or off-exchange source.


How Much Worse Does it Get?

It gets quite a bit worse actually. 

We do not know the breakdown of the 1.9 million people who gained healthcare coverage through other means than the Medicaid Expansion but what we do know is that, since the opening of the healthcare Marketplace, 5 million new jobs have been created.  If just 10% of those new jobs provided healthcare insurance to their new employees this 1.9 million figure would be reduced by a half million.  If 44.5% of those new jobs provided healthcare insurance to their employees, as reported in a 2013 Gallup-Healthwaystudy, it would wipe out the 1.9 million figure in its entirety and then some.

How many of these new jobs are providing the employee with healthcare insurance we do not know but I think it is more than safe to assume that more than 10% do and it would not be inconceivable that 40% could be doing so, based on current trends.  This certainly gives us something to think about.  And let’s not forget, there are still those individual who purchased their healthcare plans off-exchange.


And It Could Be Even Worse!

Gallup-Healthway Well-Being is not the only industry expert studying the effect that ObamaCare has had on the reduction of the nations uninsured.  Other well respected organizations such as the Rand Corp, the Commonwealth Fund and the Urban Institute all have performed similar studies with varying results.

For example, sometime after the close of the first open enrollment period, each of these groups conducted their own studies on the effect ObamaCare was having on the reduction of the uninsured. Their results ranged from 9.5 million to as low as 8 million.  For the same period the Gallup-Healthway survey concluded a reduction of 10.3 million, more than 20% higher than the lowest resulting study.  It would be impossible to determine which of these studies was the most accurate and it is not important to do so.  What is important is to understand and accept that there could be as much as a 20% variation in the results of these studies. 

Clearly, which study HHS choses to adopt to represent the overall reduction of the nations uninsured will have a significant impact when determining the number of people who could have possibly obtained a healthcare plan through the state and federal healthcare exchanges.  If you were to lower the current adopted figure of 15.3 million by 20% you would actually arrive at a net negative enrollment through the exchanges.  (12.2 million – 13.4 million)
 

Enrollment May Even Be Upside Down

The pool of 28 million people qualified to participate on the healthcare Marketplace may have actually grown since open enrollment began.

As many as 2.2 million people are likely to have gained healthcare insurance through their new employer since ObamaCare enrollment started.  This figure surpasses the 1.9 million maximum non-Medicaid Expansion enrollments to date.  For this to happen the pool of uninsured qualified to participate on the healthcare Marketplace would have to grow by 300,000.  Of course, every one of those 2.2 million who likely gained insurance through their employer were not all uninsured but a good majority of them were.

A fair look at the overall reduction of the nations uninsured would all but close the gap between the overall reduction figure and those who have taken advantage of the Medicaid Expansion.  There being a 20% disparity between the results of the highest and lowest studies conducted by four of industries leading experts, if we were to take the average results the overall reduction in the nation’s uninsured would be reported at roughly 13.8 million.  With 13.4 million having taken advantage of the Medicaid Expansion, this accounts for almost all of the nation’s reduction of the uninsured leaving virtually all of the pool of 28 million eligible to participate on the healthcare Marketplace untouched. 

If the full 20% disparity were applied, the overall reduction in the nation’s uninsured would be reported at around 12.2 million.  Taking in to consideration the 13.4 million who have taken advantage of the Medicaid Expansion, this would mean that the pool of 28 million people who are eligible to participate on the healthcare Marketplace would have to grow by 1.2 million.


One Last Point

All this number crunching has my head spinning but it is important to take the time to drill down on these figures and understand how effective (or ineffective) the individual mandate has been in reducing the pool of 28 million uninsured Americans who are not qualified for Medicaid.   As you can see, things do not look so good, in fact that look beyond terrible.  Based on these finding, the Individual Mandate is a total failure and may actually be driving the uninsured rate up instead of down.

This was concluded using numbers derived, adopted and published by HHS and therefore are endorsed by the Obama Administration.  These are their numbers, they own this!

HHS Makes 14.1 Million Uninsured People Magically Disappear

Competing with all the election news and troubles in the Middle East last week, it didn’t take long for 2016 ObamaCare enrollment projections to get lost in the noise.

Last Thursday, Department of Health and Human Services (HHS) Secretary Sylvia Burwell released a news brief in which, buried amongst dozens of facts and figures, she released the less than stellar enrollment projections for the forthcoming opening of the ObamaCare exchanges.

 

“Finally, there are those who will come from the 10.5 million eligible uninsured. We expect to draw in about 2.8 million to 3.9 million of those individuals.” 

HHS expects that somewhere between 2.8 to 3.9 million uninsured individuals will purchase a healthcare plan through the state and federal healthcare exchange this coming open enrollment period.  While this figure is significantly lower than the 6 million originally projected when the law was passed, considering the abysmal turnout by the uninsured during the first two open enrollment periods, this is actually is a pretty lofty goal.  But I will save my amateur analysis of what I believe is Burwell’s unachievable enrollment projections for my next blog.  For now, there is a much more sinister figure reported in her news brief that needs to be brought to light.

Where Did This Number Come From?

10.5 million eligible uninsured, did I read that right?  Seriously, where did this number come from?  I’m pretty in tune to all the facts and figures related to ObamaCare enrollment and 10.5 million is not a number that I am familiar with.  But that’s okay, since it represents the number of uninsured eligible for Marketplace coverage, it should be simple to validate, all we need is a starting point and the number of long term uninsured that have purchased and maintain a qualified healthcare plan through one of the state and federal healthcare exchanges to reduce it by.

First, the starting point.  In 2009 the US Census Bureau reported that 48 million Americans lacked health insurance.  Of those 48 million, 29 to 30 million were eligible for Marketplace coverage.  The balance, of course, would be those qualified for Medicaid. 

Next, the number of long term uninsured that have purchased and maintained a qualified healthcare plan.  As no department of the Obama Administration reports this number specifically, we are going to have to do the leg work ourselves.  Fortunately HHS does provide us with enough information to do so.

From the HHS ASPE Data Point report released on September 22, 17.6 million uninsured individual are reported to have gained health insurance coverage since the implementation of the Individual Mandate on January 1, 2014.  This figure includes all forms of individual healthcare insurance including on-exchange purchases, off-exchange purchases and Medicaid.  For roughly the same period, the Centers for Medicare & Medicaid Services (CMS) reported that there were 13.2 million individuals enrolled for Medicaid as a direct result of the Medicaid Expansion.  When we reduce the total number of those who have gained healthcare insurance by the number who have gained coverage through the Medicaid expansion we are left with 4.4 million {4.4 million is a significant overstatement of the actual on-exchange enrollment which I will address in my next blog}. 

So, if there were around 29 million in the pool of the uninsured eligible for Marketplace coverage at the start and we reduced that number by the 4.4 million uninsured who purchased a healthcare plan during the first two open enrollment periods then the remaining pool of uninsured should be roughly 24.6 million.  Wow, that’s a far cry from the 10.5 million HHS is reporting. Somewhere, somehow HHS made 14.1 million uninsured people magically disappear!


Where did the 14.1 Million Missing Uninsured Disappear To?

The better question is, where did HHS come up with 10.5 million as the number of uninsured eligible for Marketplace coverage?  And I have that answer!

Sadly, but hardly surprising, HHS willfully mislead the American people.  HHS arrived at their 10.5 million figure simply by reducing the original pool number of 28.1 million¹ by the 17.6 million reported to have gained healthcare coverage in the HHS ASPE Data Point report.

Likely at the direction of the White House, since the day the healthcare exchanges first opened, HHS has routinely misrepresented Marketplace enrollment by including Medicaid expansion participants in to the count.  Less than 25% of the 17.6 million HHS used to derive the 10.5 million figure actually makes up enrollment through the healthcare exchange.
¹ The size of the pool varies slightly depending on which source is use.  I chose to use the US Census Bureau figure as it is easily verifiable, HHS uses CBO data which also varies from one report to the next.


Why Would They Do Such a Thing?

Tell me, what looks better to the people, reducing the number of uninsured from 28 million to 24 million or reducing the number of uninsured from 28 million to 10.5 million?  Reporting a greater reduced pool of uninsured helps the Obama Administration play down the failure of the Individual Mandate.  The Obama Administration started doing this the first day the healthcare exchanges opened and has been doing so ever since.  And what has the media done?  The media has given the administration a fee pass on this gross misreporting of the numbers.

The faux 10.5 million figure also helps to improve how participation of the uninsured looks.  Let’s assume, for example, that HHS meets their projected goal of 4.4 million uninsured enrolling through the healthcare exchanges.  This would equate to the enrollment of 1 out of every 2.3 of those eligible to purchase a healthcare plan as opposed to 1 out of every 5.7 of those eligible to purchase a healthcare plan if compared to the actual uninsured pool of 25 million.


ObamaCare is without a doubt in serious trouble and the intentional misrepresentation we see here is affirmation of that.  And with guaranteed premium increases coming for 2016, we could be looking at a net negative enrollment this coming open enrollment period.

How many have actually purchased and continue to retain a qualified healthcare plan from the pool of 29 million eligible to participate on the Marketplace has not been answered definitively and remains one of the best kept secrets of the Obama Administration.  But as more enrollment information finds its way to the public a better picture of past, present and future enrollment can be painted, which is the topic of my next blog.

How many of the Uninsured will ObamaCare Really Insure?

“I don’t have to explain to you that nearly 46 million Americans don’t have health insurance coverage today.  In the wealthiest nation on Earth, 46 million of our fellow citizens have no coverage.”  -  President Obama, August 2009

That same year, the Census Bureau reported that 48 million Americans lacked health insurance.

While the issue of affordability can be argued, the fact that ObamaCare did and continues to provide “access” to healthcare for those 48 million uninsured Americans remains true.  However, it was, is and will continue to be unrealistic to believe that the majority of those 48 million will ever actually gain any form of healthcare insurance coverage simply because it is mandated by law.

Yes, there has long been a group of Americans who have been denied or could not afford wanted healthcare insurance but this group makes up small fraction of the 48 million who were uninsured prior to the passage of ObamaCare.  The larger portion of that 48 million uninsured choose to opt-out of purchasing healthcare insurance on their own accord and have since shown to be just as unlikely to purchase healthcare insurance under mandate of law as the were prior to ObamaCare being enacted.

 

The Financially Secure “Opt-Outs”

Roughly 20% of the 48 million who have, in the past, chosen to “opt out” of purchasing healthcare insurance come from a group of hard-working, tax paying Americans who are financially secure.  This group of the uninsured has never been denied affordable healthcare insurance nor do they place a financial burden on the healthcare system.  This group “chooses” to pay for their healthcare needs “out of pocket” and, as a result, do not find themselves running to the doctor’s office every time they have a sniffle or a headache, a common abuse by those who have healthcare insurance.

Numbering nearly 10 million, the financially secure opt-outs have taken a much more cost effective approach to manage their own healthcare needs and, as we have experienced over the past two open enrollment periods, continue to opt-out of purchasing a traditional healthcare plan despite the federal mandate to do so.

 

The Young Invincibles

Numbering around 19 million, the young invincibles make up about 40% of the 48 million, as reported by the Kaiser Family Foundation.  While a significant portion of the uninsured, they are in large very healthy thus finding little need for healthcare insurance prior to the implementation of the new healthcare law.  Little has changed in the age of ObamaCare as this group has shown little desire to bear the bulk of the burden for the older and less healthy, by paying a disproportionate amount for healthcare insurance, a key component of the ObamaCare law. 

Like the financially secure opt-outs, this large group of the uninsured has never been denied affordable healthcare insurance.  Their insured counterparts, including hundreds of thousands of college and university students, typically took advantage of low cost “bare-bones” insurance plans that were both affordable and well suited to their particular need.  However, under ObamaCare, these well suited bare-bones healthcare plans are a thing of the past.

For those under the age of 26, the problem ObamaCare created by putting an end to the well suited catastrophic plans was mitigated though a provision in the law that allows these sub-26ers to remain on their parents insurance plans.  This provision in the law is said to have increased the number of insured sub-26ers by about 3 million, according to HHS.  For the balance of the uninsured young invincibles, they were left to purchased healthcare either from the private marketplace or though one of the state and federal healthcare exchanges.  To date, very few have done so.  They are still young, invincible and see little need to spend a large portion of their meager income on insurance that they do not believe they need.

 

Those Living in the Shadows

The homeless, addicts and other small groups of American’s that sadly live in the shadows of our society make up about 15% or roughly 7 million of the uninsured.  Most of these individuals have long been eligible for some form of healthcare assistance but for whatever reason most have chosen not to or have been unable to capitalize on these offerings.  However, since the HealthCare.gov website was launched about half of those living in the shadows have come out of the “woodwork” and have enrolled on to Medicaid.
 

Pre-Existing Conditions

Amongst the 48 million there are those that have, in the past, been denied insurance due to a pre-existing condition.  The Obama Administration did a masterful job at misleading the American people into believing that their numbers ran into the millions when in fact the number is actually quite low. 

In lieu of the “guaranteed issue” that went into effect on January 1, 2014 which no longer allows insurers to discriminate against a person having a pre-existing condition, the Pre-existing Conditions Insurance Plan (PCIP) provision was put in place.  The PCIP was a stop gap that made insurance available to high risk individuals with a pre-existing condition almost immediately after ObamaCare was passed in to law back in 2010. 

When the PCIP was being crafted, it was estimated that no more than 375,000 high risk individuals that would seek enrollment.  This, in addition to roughly 200,000 that were actively participating on 35 state operated High Risk Pools (HRP), brought the number of individuals in the pool of those with a pre-existing condition and possibly seeking healthcare insurance to 575,000.  Yet, of the 375,000 estimated to participate in the PCIP, less than one third or about 1/4 of 1% of the 48 million, enrolled on to the PCIP bringing the number of individuals with a pre-existing condition and seeking healthcare insurance to just over 300,000.  That’s a far cry from the millions the president had been touting.

 

The Semi-Low Income “Opt-Outs”

The balance of the 48 million are made up of the semi-low income “opt-outs”.  Prior to the passage of ObamaCare, this pool of about 12 million fell in to a grey area where their income was too high to qualify for Medicaid yet two low to be able to afford healthcare insurance without giving up basic necessities to live.  This created a forced healthcare insurance opt-out situation.

The expansion of Medicaid eligibility criteria has opened the door for these 12 million people, most all of which have or are expected to take advantage of the Medicaid Expansion.
 

The Numbers Fit

Of the 48 million who were uninsured when ObamaCare was passed in to law it looks as though as many as 18.5 million have or will eventually seek out healthcare insurance, mostly through the Medicaid Expansion.  The remaining 29.5 million look as though they will continue to opt-out of purchasing a qualified healthcare plan for a variety of reasons.

As for those who will continue to opt-out of purchasing a qualified healthcare plan, just as they have done in the past, the majority of the financially secure opt-outs will remain responsible for their own healthcare costs.  As well, the bulk of the young invincibles will remain healthy and without the need of costly healthcare insurance.  Those living in the shadows who remain uninsured of course will continue to be a financial burden on the healthcare system.

 

What about those Uninsured with a Pre-existing Medical Condition?

The question remains unanswered as to exactly how successful ObamaCare has been in insuring the pool of people with a high cost/high risk pre-existing medical condition and if the performance of the PCIP is any indication, the law is not helping near as much as is being claimed.

The PCIP attracted only 36% of the 375,000 participants as originally projected and over its short lifespan lost 23% of its 135,000 peak enrollment in its final year, despite rate reductions of 20%.  Additionally, 20% of PCIP enrollees failed to transfer to one of the state and federal healthcare exchanges before the PCIP provision expired, even after three extensions were granted for them to do so.

It’s hard to imagine HHS over projecting, by nearly 300%, the number of individuals with a pre-existing condition that were in need of healthcare insurance.  Even if the over projection was only 200%, this would still mean that 135,000 individuals with a pre-existing condition opted-out of the PCIP provision, this in addition to the 31,000 documented attrition and the additional 20,000 that did not transfer over to the healthcare exchanges. 

But there is no real way in knowing exactly how well those with a pre-existing condition are currently being treated by the ObamaCare law.  First, we are unsure as to exactly the number of individuals with a pre-existing condition that ObamaCare could have effected and second, there is no mechanism in place to determine a person enrolling on the healthcare exchanges was one of those individuals.  And what about the states that ended their HRP programs, how many of their enrollees found their way and purchased a healthcare plan through the healthcare exchanges?  There is no way of knowing for sure.

Eventually some group will do a study to try and determine just how many of those with a pre-existing condition ObamaCare is actually helping but for now, it looks as though far fewer are being helped that the Obama Administration would like us to believe.

 

The 2016 Open Enrollment Period Will Soon Be Upon Us

The third ObamaCare open enrollment period is just around the corner and this is a make or break for ObamaCare.

Over the 9 months that made up the first two open enrollment periods the healthcare exchanges managed to attract only about 3 million customers from the nation’s pool of the non-elderly, long term uninsured, a 70% shortfall from projection.  This leaves a lot of ground to make up in addition to another 6 million uninsured that were projected to enroll through the exchanges in 2016. 

Reaching the laws 2016 goal of reducing the number of uninsured by 16 million, through the purchase of a qualified healthcare plan, is a virtually insurmountable task, achieving even 50% of the goal looks to be out of reach.  But we must go through the motions and after the open enrollment period ends endure the countless ways the Obama Administration will try and defend an unpopular law that continues to fail to meet one of its primary objectives by a significant margin.

Gaba Confirms ObamaCare Exchange Failure

Anyone that closely follows ObamaCare enrollment is familiar with Charles Gaba and his extensive efforts in compiling ObamaCare enrollment data.  Gaba’s ACASignups.net website has become the go to place for anyone and everyone seeking comprehensive, accurate and verifiable enrollment information.  And so it came with great pleasure that figures shown on his recently released 2015 enrollment graph validated my own efforts in determine the success or failure of the ObamaCare exchanges.

While Gaba’s work is geared towards determining the total number of individuals who gained any form of healthcare coverage as a result of the ObamaCare law, whole or in part, my focus has strictly been on determining the number of uninsured nonelderly that gained a qualified healthcare plan through the state and federal healthcare exchanges as insuring the uninsured is the ultimate goal of the healthcare law or at least so we were told.

From an administration which so often boasts the success of ObamaCare, one would have thought that the efforts Gaba, myself and so many others have taken to get to the bottom of enrollment would be unnecessary especially considering President Obama once claimed his administration would be the most transparent of any.  However, this has proven not to be the case and in regards to providing a breakdown on the make-up of enrollment, there has been nothing short of an information blackout from the Obama Administration both in 2014 and again in 2015.  It stands to reason I guess once you realize how poorly the exchanges have actually performed in insuring the uninsured, the Obama Administration really does hate to broadcast its failures.

At this point in the game some 10 million uninsured nonelderly individuals were expected to have purchased a qualified healthcare plan through the state and federal healthcare exchanges, as projected numerous times by the Congressional Budget Office (CBO), as was accepted as the enrollment goal by the Obama Administration and most important, as used as terms to sell the law to congressional lawmakers and the American people.  Sadly, participation by the uninsured looks to be about one third that.


The Uninsured Don’t Seem to be Interested in ObamaCare

For a very long time I stood alone with my very low prediction in the number of uninsured that ultimately purchased a healthcare plan through the ObamaCare exchanges in 2014.  With each new study released quantifying the nations uninsured population and with each revised report on Medicaid enrollment released by the Department of Health and Human Services (HHS), it became more and more evident that Medicaid enrollees were taking up most of the picture, leaving little room for the uninsured who purchased a healthcare plan.  But nobody was reporting this, at least not the low enrollment figures I was arriving at.

For 2015, with HHS providing weekly enrollment reports for the federal healthcare exchange, along with data collected from various other reliable industry sources, I attempted to project how effective the ObamaCare exchanges were in attracting America’s uninsured population.  I posted my final projections in an earlier blog dated February 25th.  As stated in the blog, for 2014 the ObamaCare exchanges appear to have attracted a mere 1.4 million uninsured enrollees while 2015 fared better with an uninsured enrollment of 2.3 million.

Of course, me being an unknown entity, my projections have come under great scrutiny by many low information proponents of ObamaCare too apathetic to do a little research and some basic math in fear of proving themselves wrong.  But those who have called my projections into question have been put in check as I am no longer that lone wolf out their touting the failure of the ObamaCare exchanges, I now have the ultimate ObamaCare enrollment support group, Charles Gaba and his graphs!

Now let me be clear, I am not implying that Charles Gaba has endorsed my little know blog, my opinion or my findings, it’s not likely that Gaba has even the slightest inkling as to who I am.  However, in his highly accepted reporting of enrollment, he has provided what is a very rare commodity, the actual reporting of the number of uninsured that have participated on the healthcare exchanges.

From Gaba’s website in regards to his enrollment findings:

“However, now that every state (except for Idaho) has been updated through at least February 15th, here, once again, is the complete 2015 ACA enrollment graph, showing the rough breakout of all 32.3 million people whose current healthcare coverage is either wholly or partly due specifically to the Affordable Care Act.

Again, that does not mean that all 32.3 million were uninsured to begin with. By my best estimates based on the available data, I estimate that around 19 million already had some form of insurance coverage. Around 11 million were uninsured prior to January 2014, and around another 2 million were uninsured prior to January 2015.”

In 2014, of the 11 million reduction of the uninsured reported by Gaba, 9.5 million are true Medicaid enrollments directly linked to the Medicaid expansion, as depicted in his graph.  This leaves no more than 1.5 million possible uninsured enrollments through the ObamaCare exchanges during the 2014 open enrollment period which is in close agreement to the 1.4 million enrollment figure I arrived at.

For 2015, Gaba states that another 2 million of those who now have healthcare insurance were uninsured prior to January 2015.  This too is not far off from my more generous prediction of 2.3 million.

Gaba and I did not reach our conclusions using the same method which brings increased validity to these numbers. 

My method was quite simplistic and for 2014 I used nothing more than a study from a well-respected industry source as my baseline for the reduction in the nations uninsured and subtracted the number of those taking advantage of the Medicaid expansion over the same period, as reported by HHS.  The difference is the maximum possible number of uninsured that could have purchase a qualified healthcare plan through the ObamaCare exchanges.  It does not take in to account any off exchange enrollment which would drive the figure down even lower.

For 2015 I compiled HHS weekly enrollment reports along with a little internet research to estimate the number of transfers to the ObamaCare exchanges from other marketplaces.  My method for both years is better explained in an earlier blog post of mine. 

Gaba on the other hand amasses tons of enrollment data from numerous sources to create his data table.  Gaba’s method is significantly more accurate but when dealing with figures well into the millions, being off by a few thousand is not enough to change the argument.

Two very different and verifiable methods both conclude that after two open enrollment periods (9 full months plus extensions) and from a pool of 40 million uninsured nonelderly Americans eligible to purchase healthcare plans through the ObamaCare exchanges, significantly fewer than 4 million chose to do so.  You can draw your own conclusions as to the effectiveness of the ObamaCare exchanges in attracting the uninsured.

Is ObamaCare Fulfilling Its Intended Purpose?

If you are a proponent of ObamaCare then you are likely to stand by the claim that ObamaCare is working great and helping millions of people and in some regards you would be right.  Certainly the Medicaid expansion has helped millions gain the security of healthcare coverage but honestly, how hard is it get people to sign up for something when it is FREE, especially when that FREE is someone else paying the tab on your healthcare!  The Medicaid expansion can hardly be used as a measure of the success for the massive healthcare law much less deem it a major accomplishment as again it is FREE to the end user!

Beyond the Medicaid expansion there is little else that has gone well for ObamaCare.

Insuring the Uninsured Nonelderly  -  As we have already ascertained, enrollment of the uninsured nonelderly through the ObamaCare exchanges has missed its mark nearly threefold and there is every reason to expect future enrollment to get worse instead of better.  As premiums and deductibles continued to rise, the pool of interested uninsured participants shrinks. 

Overall, participation on the ObamaCare exchanges will increase significantly in the coming enrollment periods as more employers terminate the healthcare relationship with their employees the majority of which will likely transfer over to the ObamaCare exchanges in search of taxpayer funded subsidies.  But as for the uninsured, they will continue to be a scarce commodity.

Reducing HealthCare Premiums  -  Despite all the signs of increased premiums heading our way back in 2013, President Obama remained adamant that his signature healthcare law would lower premiums on the individual marketplace.  And it was on the eve of the rollout of the HealthCare.gov website that he took a victory lap while exclaiming “See, ObamaCare Works”, this happening shortly after the Governor of New York released the insurance rates that would be offered on their state run exchange.

The liberal media was all over the story of the 40% rate reduction in New York while they ignored reporting on the reality that was faced the next morning, a reality that industry experts such as the Manhattan Institute had been reporting on during the months, weeks and even days leading up to the rollout.  While New Yorkers were elated to finally be able to afford healthcare insurance, residence in 43 other states (including DC) woke up to a very different reality.  In each of those 43 states insurance premiums offered on the ObamaCare exchanges increased on average, compared to the previous years rates on the individual healthcare insurance marketplace.  36 of those states realized an increase of 20% or greater, six of which had an average rate increase of over 80%. 

The Obama Administration’s response to these near nation-wide rate increases was at the very least pathetic.  Sweeping over the fact that the law failed to reduce individual insurance premiums as promised, the administration’s reply to the question was that with subsidies, most would still see a reduction in their insurance premiums.  This gave little comfort to the millions whose insurance policies were canceled and ended up paying more through the ObamaCare exchanges, even after subsidies.  As well this provided little comfort to those picking up the tab.  This was neither the plan nor the promise made by the Obama Administration and Democratic Lawmakers who forced this law upon the American people.   

So why did the State of New York experience such a rate reduction windfall while all others did not?  The answer is simple, New York and a very broken healthcare system due to decades of overregulation and attempts to do the very same thing the ObamaCare law is now attempting to do nation-wide.  Similar to how RomneyCare worked well in fixing the broken healthcare system in the State of Massachusetts, the ObamaCare model was well suited to address the problems faced by the State of New York’s broken healthcare system.  Unfortunately this one-size-fits-all approach is not suited for the balance of the states which were not suffering from the same overregulation and out of control rate issues as New York and a small handful of other states. 

And let us not forget that before ObamaCare came into existence, healthcare insurance on the individual marketplace was affordable to most working Americans even without subsidies.  What have we really accomplished here?

Slowing the Growth Rate of Healthcare Costs  -  When President Obama speaks of the slowing in the growth rate of healthcare cost, listen closely to what he says or more important, what he does not say.  At no time does the president ever tie the slowing growth rate of healthcare costs to his signature healthcare law although the subject is always brought up when he is touting the law’s success.

There is no denying that the growth rate in healthcare costs has slowed however, this is a trend that started in 2009 and before ObamaCare was a bill much less a law.  Economist and industry experts, including the CMS actuary, contribute most if not all of the slowdown in growth to the 2007/2008 recession and slow economic recovery.  As well, they expect growth to return to its previous rate once the economy returns to normal as ObamaCare has done little to reform the actual cost of healthcare. 

In a nutshell, ObamaCare has done nothing measurable that can attribute to the slowdown in the rise of healthcare costs and the president never actually states that it does.

Insuring Those With Pre-Existing Conditions  -  One of the grandest lies perpetrated by the sellers of ObamaCare was that the law would ensure that millions who have been denied affordable healthcare due to a pre-existing medical condition would no longer be discriminated against.  Millions, what millions?

In an attempt to mislead the American people as to the severity of the pre-exiting condition issue facing or nation, then HHS Secretary Kathleen Sebelius and the president publically stated that without healthcare reform 129 million people with a pre-existing medical condition could be denied affordable {healthcare} coverage, a claim also published in an report issued by HHS.  Of course democrats ran wild with this claim and used it to demonize those heartless republicans who opposed the law. 

There is no question that for decades private healthcare insurers have denied coverage to many with high cost/high risk medical conditions but for the administration to insinuate that there are millions or even potentially millions of people with a pre-existing condition that could suffer without healthcare reform is nothing short of a fairy tale  And to support the fairy tale claim, when the High Risk Pool provision, better known as the Pre-Existing Condition Insurance Plan or  PCIP, of ObamaCare was created, CMS Chief Actuary reported that only 375,000 people would enroll in this provision.  What happened to all those millions?

Only those with their heads buried three feet in the sand actually believed that 129 million people could be affected by the new healthcare law, most did believe the number to be well into the millions however, as that is what was repeatedly told to them since the day Obama was sworn into office.  But the real kicker is, of the 375,000 estimated to be in need of assistance through the federal PCIP provision, as stated the CMS Chief Actuary, ObamaCare managed to attract fewer than 135,000 participants across all 50 states and DC over the three and a half years the federal PCIP program was in play.   

During the first year the federal PCIP was made available, fewer than 50,000 individuals enrolled on the program and by the end of 2013, enrollment increased to just under 135,000.

So why so few enrollees, did CMS get it wrong?  Likely not, at least not in regards to enrollment estimates, but they did get the cost wrong.  As it turns out, there was little affordability provided in the federal PCIP and therefore nearly two thirds of the projected enrollees remained lock out just as they had been in the past, they simply could not afford the insurance being offered to them.  In addition to the high buy in cost of the federal PCIP, the administration grossly underestimated the overall cost to cover the medical needs of those who did enroll.  With barely over one third the projected enrollment the federal PCIP still ran through its entire budget and actually cut off enrollment early to prevent having to ask congress for more money.

It is hard to fathom that the Obama Administration wasted so much time, energy and American tax dollars creating the unaffordable Affordable Care Act which continues to leave the very people it was intended to help, out in the cold.  And let us not forget that the combined enrollment of the state and federal PCIP programs numbered in the hundreds of thousands not tens of millions as the Obama Administration wished us all to believe.
 

ObamaCare is clearly missing all of its marks.  So despite all the claims of greatness and the continued rhetoric from the left against those who oppose the law, the president’s legacy legislation has turned out to be nothing more than an extremely costly expansion of the Medicaid system which has unnecessarily transformed the private insurance industry and has driven affordability so far out of individual healthcare plans that even under federal mandate and massive fines, the uninsured still reject the law. 

Based on the long list of ObamaCare failures, any congressional lawmaker that possesses an ounce of moral fabric, any degree of fiscal responsibility and claims that he or she is looking out for the overall best interest of the American people should be screaming at the top of their lungs to repeal this law.  And judging from all the laws shortcomings, I think it is safe to say that any alternative to ObamaCare would be a marked improvement.

ObamaCare Enrollment Week 11 - The Marketplaces are Failing

For the 11th week of open enrollment on the Federally Facilitated Marketplace (FFM), the Department of Health and Human Services (HHS) reported that 179,710 plans were selected, a nice increase over the previous week.  If enrollment continues to improve over the final two weeks, which it likely has, HHS could in fact reach its enrollment projection but only after having significantly changing the goals of the federal and state operated marketplaces as well as the ObamaCare law itself. 


HHS Has Changes the Goal of the Marketplace and ObamaCare

Once upon a time the goal of the stated and federal operated marketplaces was to put a qualified healthcare plan in the hands of 24 million uninsured nonelderly Americans by 2017.  The Obama Administration seems to have drifted from that goal considerably however, and through a conscious effort put forth by HHS, has taken the proponents of ObamaCare along with them.

The change started almost immediately after the HealthCare.gov website rolled out in October 2013 when it became apparent that the bulk of early enrollments on the healthcare exchanges were a product canceled healthcare plans.  Overnight HHS seemed to have dropped the term “uninsured” from its vocabulary and strictly referred to activities on the exchanges as enrollments. 

Even with constant pressure from Republican Lawmakers and opponents of the healthcare law, for HHS to provide enrollment data that differentiated between the number of uninsured verses reinsured that had enrolled on the exchanges, with the support of the White House, HHS has avoided doing so to this day.  And while 6.7 million individuals may have obtained a qualified healthcare plan through the state and federal exchanges in 2014, as few as 1.4 million of those plans might have actually made it in to the hands of the formerly uninsured, a significant shortcoming from the 7 million the president himself once proclaimed would have the security of securing healthcare insurance through the marketplace by the close of the inaugural open enrollment period.

And the change continues.  This open enrollment period HHS does not refer to “uninsured” at all.  The distinction in enrollment made on the FFM is between renewals and new consumers, the definition of which the latter has nothing at all to do with the uninsured.  Here is how HHS defines a new consumer as taken directly from the Week1 HHS enrollment blog:

New Consumers: New consumers are those consumers who are selecting a plan for the first time or whose plan selection in 2014 was terminated, because, for example, they failed to pay their premium or gained coverage through employer-sponsored insurance. In addition, because Oregon and Nevada consumers now use the Federally Facilitated Marketplace platform, they are considered new enrollments.

Keeping in mind that this definition pertains only to how HHS classifies a New Consumer on the FFM, it is significant that in this definition HHS points out that the state of Oregon and Nevada are considered new enrollments.  Why is this significant?  It is so as it explains how the FFM distinguishes between enrollments. 

For the 2015 enrollment period, the FFM has only two distinctions, renewals and new enrollments.  To be counted as a renewal, the customer’s 2014 enrollment had to be made through the FFM so that when they returned in 2015, they would be recognized on the FFM database and counted as a renewal.  Customers enrolling on the FFM but not recognized on the database are all considered new enrollments regardless of their previous insured or uninsured status.  For example, those who lost their 2014 employer sponsored insurance and those who were insured on a state facilitated marketplace 2014 and transferred to the FFM in 2015 are counted as new enrollments or new consumers regardless of the fact that they were previously insured.   After week 5 of the open enrollment period the auto re-enrollment period ended and all plans selected beyond that point were considered to be new enrollments aka new consumers. 

There is absolutely no distinction made between an uninsured and previously insured individual on the FFM other than recognized renewals, at least not in HHS’s reporting, and this appears to be the way HHS and the Obama Administration wants it to be.  The goal of the state and federal healthcare exchanges no longer seems to be to insure the uninsured.

Have the Exchanges Achieve Their Enrollment Goal?
 
Whether or not the enrollment goal for 2015 has been met depends on ones understanding of what the goal is or at least was.

Here is the forecasted change in uninsured taken directly from Table 1 of the CBO’s May 2013 Estimate of the Effects of the Affordable Care Act on Health Insurance Coverage report {see full report here}:

EFFECTS ON INSURANCE COVERAGE                      2013       2014       2015       2016       2017
(Millions of nonelderly people by calendar year)

Change                  Medicaid and CHP                             1              9              12           12           12                                 Employment-Based                          2              *              -2            -6            -6                                 Nongroup and Other                         *              -2            -3            -4            -5                                 Insurance Exchanges                        0              7             13           22           24                                 Uninsured                                         -2            -14          -20          -25          -25

It’s no coincidence that the enrollment goal originally touted by HHS during the 2014 enrollment period was 7 million nor is it a coincidence that, before their last minute revision, the goal for 2015 was 6 million {7+6=13}.  These enrollment targets adopted by HHS were taken directly from the CBO forecast provided to HHS, at their request, and are indisputably earmarked for the uninsured. 

It is important to understand that these enrollment forecasts were also provided to and utilized by insurers who used them in their rate calculations for plans they would offer on the exchanges.  With this in mind, it is easy to conclude that any significant shortcoming in the enrollment of the uninsured will have an impact on future rates set by the insurers and possibly even a particular insurer’s participation on the exchanges.

To put a little history to the original intent of the law, we need to look no further than the CBO report prepared for then Speaker Nancy Pelosi in response to her request for spending estimate revisions outlined in H.R. 4872, the Reconciliation Act of 2010, the House Bill that would be voted on and would push the ObamaCare bill forward to final signing by the President.  Two excerpts from page 9 of the CBO report make it clear that the goal of the insurance exchange was for 24 million uninsured nonelderly to purchase a healthcare plan through insurance exchanges that would be set up as part of the law {see full report here}:

 

the combined effect of enacting H.R. 3590 and the reconciliation proposal would be to reduce the number of nonelderly people who are uninsured by about 32 million

and

 

Approximately 24 million people would purchase their own coverage through the new insurance exchanges, and there would be roughly 16 million more enrollees in Medicaid and the Children’s Health Insurance Program than the number projected under current law.

The goal to significantly reduce the number of uninsured through the exchanges is again emphasized in another CBO analysis produced a year after the law was enacted.  The report was prepared as part of testimony for a Subcommittee hearing regarding the Affordable Care Act.  An excerpt in the summary reads as follows {see full report here}:

In 2021, approximately 24 million people will purchase their own coverage through insurance exchanges, and Medicaid and the Children’s Health Insurance Program(CHIP) will have roughly 17 million additional enrollees, CBO and JCT estimate.

Table 3 in the same report concludes that 23 million will have obtained insure through the exchanges by 2017.

These are just a few examples that make the goal of the healthcare exchanges clear and indisputable.

Back to Week 11 Enrollment

Here are the enrollment figures HHS has reported for the first 11 weeks of the period:

Week 1  -  462, 125 plans selected, 51% new enrollments (235,684)
Week 2  -  303,010 plans selected, 49% new enrollments (148,475)
Week 3  -  618,548 plans selected, 48% new enrollments (296,903)
Week 4  -  1,082,879 plans selected, 47% new enrollments (508,953)
Week 5  -  3, 927, 484 plans selected, 17% new enrollments (667,672)
Week 6  -  96,446* plans selected
Week 7  -  102,896* plans selected
Week 8  -  163,050* plans selected
Week 9  -  400,253* plans selected
Week 10  -  137,298* plans selected
Week 11  -  179,710* plans selected
* No distinction between new enrollment and renewals provided

For the 11 weeks reported, there have been 7,473,699 plans selected though the FFM.  Based on current enrollment trends, this should bring the cumulative total of both the state and federal marketplaces, for the full open enrollment period, to roughly 10.3 million.  If a robust last minute surge in enrollment were to occur it would come as no surprise if as many as 11 million plans were selected before the marketplaces close their doors on 2015 shoppers. 

As for the number of uninsured that are expected to show up for the party, there is reasonable disagreement between the My Daily POV model and what is being projected by HHS, neither of which comes close to the original CBO projection of 6 million.
 

How Many Uninsured Will Gain Healthcare Coverage Through the Marketplaces?

Just how many of America’s uninsured nonelderly population will have gained healthcare coverage through the state and federal marketplaces this open enrollment period will depend largely on who you ask.  If last year is any indication, we should not hold our breath waiting for HHS to release a breakdown of the enrollment figures but then again, under the new leadership of Secretary Sylvia Burwell, HHS has been a great deal more forthcoming with information, lest we forget however, that the White House still controls the puppet strings. 

HHS has not provided an actual figure as to the number of uninsured they predicted to gain healthcare coverage through the marketplaces this open enrollment period however, they have eluded to it in a round about way, without committing to an actual figure.

HHS has broken away from using the CBO forecast as their target and instead have developed their own “bottom-up” methodology in predicting enrollment.  The fundamentals behind their newly adopted methodology are described in a report they issued just days before the 2015 open enrollment period started {see full report here} in which HHS also disclosed their lowered enrollment projection of 9.1 to 9.9 million for the period.  This projection of course includes all renewals, transfers and newly insured marketplace customers. 

A hint of what HHS expects in the way of enrollment by the uninsured is given in this excerpt taken directly from the report {see bottom of page 4 and top of page 5}:

HHS’s analysis implies that most of the new Marketplace enrollment for 2015 is likely to come from the ranks of the uninsured, with approximately three or four previously uninsured new enrollees for each new enrollee drawn from the ranks of those who previously had off-Marketplace individual coverage.

In other words, for every 1 off-marketplace transfer to one of the state and federal marketplaces, HHS is concluding that an additional 3 to 4 of American’s uninsured would sign up for a qualified healthcare plan through the exchanges as well.

This is a pretty ambitious claim being made by HHS and one that prompted some digging into the numbers.  And while anything is possible, what a little number crunching revealed was that the chances of HHS’s claim to come to fruition are slim to none, siding heavily to the side of none.

Starting with the lesser side of the claim, that for every 1 transfer 3 uninsured would enroll through the marketplace, based on the current rate of enrollment, the number of renewals reported and the know number of off-exchange transfers that will affect 2015 marketplace enrollment, for the HHS claim to hold water the following would have to occur:

·         Total enrollment would have to reach a minimum of 11.6 million, an increase of almost 1.7 million in the final two weeks.

·         The very least number of expected off-exchange transfers would have to occur.

·         A 2014 retention rate of 100% must be achieved.  HHS however predicts only 83% retention of 2014 marketplace enrollments.

It is unlikely that any of the above listed is achievable much less all three.  Where it appears HHS may have failed the most in their projection is in accurately quantify the number of off-exchange transfers which looks as though they have completely ignored in their bottom-up projection. 

If HHS’s 3 for every 1 prediction were to be correct, the current low ball estimate of off-exchange transfers would have the number of uninsured obtaining a qualified healthcare plan through one of the marketplaces at 4 million with the total number of plans selected at 11.6 million, neither number of which is believed to be achievable.  And if we use the more realistic off-exchange transfer figure, the uninsured enrollment rate would rise to 4.3 million and the total number of plans selected would be well in excess of 12 million.  Unless HHS is making the assumption that a large percentage of those losing their off-exchange healthcare plans will chose to remain uninsured, an act that is counterproductive to the goal of ObamaCare, the model used by HHS to predict 2015 enrollment appears to be highly flawed.

As for HHS’s 4 for every 1 prediction, this would require that no off-exchange transfers take place or a total enrollment figure so high that it would be impossible to achieve.

The flawed HHS model is unable to provide a reasonable answer to the question of how many uninsured will gain healthcare coverage through the marketplace this open enrollment period so let’s consider the other model.

A Simpler Uninsured Enrollment Prediction

The My Daily POV enrollment model (the model) takes a very simplistic approach in predicting the number of uninsured that will purchase a qualified healthcare plan through the state and federal marketplaces this open enrollment period.  

The model does not consider the results of numerous studies, enrollment by age demographic or any number of other statistics that are considered in the HHS approach, the model instead relies only on enrollment data, largely provided by HHS, along with a small number of fair and well supported assumptions that have a direct impact on enrollment.  Unlike HHS, which had the misfortune of having to devise a method of predicting what the future held for enrollment, the My Daily POV model is a work in progress and improves with each week’s enrollment report as well as other aspects of enrollment we may learn and can be used to improve the fortune telling of the model.

With 11 weeks reported and at the current enrollment rate the model projects that the final cumulative number of plans selected will surpass 10.3 million. After accounting for renewals, off-exchange transfers and adjusting for attrition, the resulting number of uninsured gaining healthcare coverage through the marketplaces is predicted to be no more than 1.5 million.

What is not considered in the prediction just stated is a surge in enrollment that will likely occur in the closing weeks and days of the open enrollment period.  To what degree the surge in enrollment will be is unknown but if we assume that week 12 enrollment will be 50% greater than week 11 and the final week 100% greater than week 12, then the model projects just over 11 million plans will be selected and the number of uninsured that will obtained a qualified healthcare plan through one of the exchanges will number between 1.4 and 2.2 million.  The large disparity in the projection number of uninsured obtaining a healthcare plan stems from the number of off-exchange transfers that can be confirmed with a reasonable degree of certainty verses an unconfirmable but more realistic number of off-exchange transfers.

   
The Success of the Marketplace Put In Perspective

From the pool of 38 million uninsured Americans eligible for marketplace plans this year, the best we are likely to see is this number shrinking by roughly 2 million.    

On the outside, our current projection of 10.3 plans being sold through the state and federal marketplaces looks like a success and will be portrayed as such by the administration and the liberal media.  However, of those plans sold, 6.5 million can be attributed to plan renewals and another 1.7 million to off-exchange transfers, the majority of which originate from employer sponsored healthcare insurance program cancelations.  The Daily POV model also predicts a worst case scenario where fewer than 1 million uninsured participate on the exchanges this year but let’s be optimist and hope this not to be the case.

Similar results were experience during the 2014 open enrollment period where over 5 million plans purchased were the result of off-exchange transfers on to the state and federal marketplace.  The 2014 open enrollment period yielded as few as 1.4 million uninsured obtaining a qualified healthcare plans through the exchanges.

In Conclusion

At the close of the 2015 open enrollment period the law’s original goal to have reduced the number of uninsured nonelderly American’s  who were eligible to participate on the marketplaces by 13 million will likely fall short by 10 million.  This leaves little if any doubt that reducing the eligible pool of uninsured nonelderly Americans by 24 million, as has been the intended purpose of the marketplaces from the start, will never come close to being successful.

Unless a miracle takes place over the final days of enrollment, it should be clear now that the insurance marketplaces established by the ObamaCare law are a complete and abysmal failure.  After two rounds of open enrollment, they will have accomplished little more than to have moved the already insured from one marketplace to another while hardly putting a dent in the number of the uninsured eligible to participate on the stated and federal marketplace’s.  Even with the incentive of federal subsidies and the threat of penalty, the vast majority of American’s uninsured are simply not interested in ObamaCare.