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HHS Report Highlights “Surge” In Enrollment in Health Insurance Marketplaces

Written by: Roy Albert

Last week, HHS’s Office of the Assistant Secretary for Planning and Evaluation published a Report offering health plan enrollment data for the state-based insurance marketplaces authorized by the Affordable Care Act (“Marketplaces”).  Some states have elected to implement their own Marketplaces, whereas other state Marketplaces are supported by or are fully run by HHS.  The Report provides data for the over 8 million people that enrolled in either the state-based Marketplaces or federally-facilitated Marketplaces during the initial enrollment period ranging from October 1, 2013 through March 31, 2014.

The beginning of the initial enrollment period was quite rocky, as the widely-chronicled problems with caused some to question whether the website would derail the successful implementation of the Affordable Care Act.

Many of the most widespread problems with the website have been resolved, and enrollment at the end of the initial enrollment period surged, which HHS notes is consistent with expectations based on the experience of private employers, the Federal Employees Health Benefits Program, and Medicare Part D.  HHS specifically notes that the rate of young adults (18 to 34 years of age) entering the Marketplaces increased toward the end of the initial enrollment period.  During the last month of the initial enrollment period, the number of young adults who selected Marketplace plans doubled from approximately 1.1 million to over 2.2 million.  HHS’s focus on young adults is predicated upon the belief that participation of younger people in health insurance risk pools is essential to the success of the Marketplaces, as younger often more healthy people must offset older individuals who may require greater health expenditures.

The Report provides a wide range of statistics of individuals who have selected Marketplace plans during the enrollment period:

  • Age Breakdown:  Marketplace enrollees fell into the following age categories:  6% under 18 years of age, 28% between 18 and 34 years of age, and 65% between 35 and 64 years of age.
  • Gender Breakdown:  Marketplace enrollees are 54% female and 46% male.
  • Plan Selection by Metal Level:  The majority of enrollees selected silver plans (65%) followed by bronze plans (20%).
  • Plan Selection by Financial Assistance Status:  Eighty-five percent (85%) of Marketplace enrollees are eligible to receive financial assistance.
  • Consumer Interest:  There have been 98 million website visits and 33 million calls to call centers.

HHS provides several disclaimers about the Report’s data, which may cause critics to question the data’s validity:

  • The initial enrollment period for the Marketplace lasted from October 1, 2013 through March 31, 2014, but the Report also includes data through April 19, 2014 from a “special enrollment period.”  Individuals could enroll during the special enrollment period if they started – but did not complete – the enrollment process on or before March 31, had a qualifying event that made them eligible to enroll during a special enrollment period, or experienced a “complex situation” when applying for coverage in the Marketplace.
  • The data does not represent individuals who have already paid their premiums.  Instead, the Report references statements made by certain insurers estimating that 80 to 90 percent of the people who have selected a Marketplace plan have made premium payments.

Despite these disclaimers, a recent Gallup poll verifies the trends described in the Report, as the rate of individuals without health insurance has dropped markedly from 17.1% in the fourth quarter of 2013, to 13.4% at the end of April 2014.

With the initial enrollment period over and expanded coverage already obtained, attention is likely to shift from the enrollment numbers toward patient experience in Marketplace plans.

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Roy Albert