Documents Show Low Exchange Enrollment During First Week

On Thursday, House Oversight and Government Reform Committee Chair Darrell Issa (R-Calif.) released documents that show just six U.S. residents purchased coverage through the federal health insurance exchange on the first day of open enrollment, Reuters reports (Cornwell/Morgan, Reuters, 10/31).

The documents, which are labeled "war room" notes, appear to have come from meetings involving CMS, federal contractors and Obama administration officials regarding the website's rocky launch (Easley, "Healthwatch," The Hill, 10/31).

The ACA exchanges opened for enrollment on Oct. 1, but many people seeking to shop for coverage experienced technical difficulties (Reuters, 10/31).

The documents stated on Oct. 2 "[six] enrollments have occurred so far with [five] different issuers'' (Welch, USA Today, 11/1). By the afternoon, 100 individuals had enrolled, and 248 people had purchased coverage by the morning of Oct. 3 ("Healthwatch," The Hill, 10/31).

In addition, the documents detail some of the problems that the administration was facing with the federal exchange website, such as an inability to process many applications because of various system failures caused in part by overloaded capacity. The documents stated that as of Oct. 2, direct enrollment -- in which an applicant signed up directly on insurers' websites -- was "not working for any issuers" (USA Today, 11/1).

HHS Response

HHS spokesperson Joanne Peters said that the notes are unofficial numbers and "do not include official enrollment statistics." She added, "As [HHS Secretary Kathleen Sebelius] said before Congress, we are focused on providing reliable and accurate information and we do not have that at this time." Peters noted that such information, which will likely be released by mid-November, will include enrollment figures from call centers, as well as paper applications and data from insurers and states (Reuters, 10/31).

Medicaid Enrollment Outpacing Private

Meanwhile, state data show that a disproportionate number of people who have obtained coverage through the exchanges have enrolled in Medicaid and not private coverage, the Washington Post's "Wonkblog" reports.

Some experts had projected that nine million U.S. residents would enroll in Medicaid in 2014, slightly more than the seven million consumers who are expected to enroll in private coverage through the exchanges.

However, states that have released some enrollment data show a wide gap between the two programs. Matt Salo, head of the National Association of Medicaid Directors, said that in some states nine out of 10 individuals who have obtained coverage have enrolled in Medicaid.

The data show:

• Arkansas has received 70,595 Medicaid applications, but has no data on private coverage enrollment;
• Connecticut has 1,950 Medicaid enrollments, compared with 1,897 in private coverage;
• Kentucky has 25,654 Medicaid enrollments, nearly four times the 5,891 private insurance enrollments;
• Maryland has 82,473 Medicaid enrollments, compared with 3,186 residents in in private coverage;
• Minnesota has 2,496 Medicaid enrollments, compared with 406 in private coverage;
• Oregon has 62,000 Medicaid enrollments, while technical issues prevented anyone from signing up for private coverage; and
• Washington has 42,605 enrollments in Medicaid, compared with 6,390 in private insurance.

Some supporters of the law caution the early data, noting that technical difficulties might be skewing the figures.

According to "Wonkblog," the financial implications of higher-than-expected Medicaid enrollment are not clear. Medicaid coverage -- which cost the government $4,362 per non-disabled adult in 2011 -- is less costly than the average $5,500 the Congressional Budget Office projects the government will pay per subsidy.

The federal government will initially pick up the entire cost of people who are newly eligible for Medicaid under the ACA's expansion of the program. However, states have to help cover the cost of residents who were eligible for Medicaid before the ACA expansion but are just now enrolling, which experts say could be costly for some states. For example, in Washington, the state will have to help foot the bill for about one-third of new Medicaid enrollees (Kliff, "Wonkblog," Washington Post, 10/31).