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Are they signing up for Obamacare, or for Medicaid?

Written by . Posted in 2014 Campaigns, Featured, Issue Watch

Published on October 18, 2013

CaptureHow many people have tried to sign up for Obamacare? How many have completed the process?

Those numbers are important, but let’s keep something else in mind here — there’s another important number that a lot of publications are failing to separate out. That is, how many people are enrolling in the private insurance plans within the Obamacare exchanges — as opposed to those applying who report very low incomes and get steered into the Medicaid program?

I haven’t been able to find a copy of the memo the AP obtained on this topic, but when the administration set its goal of 500,000 enrollments this month, it appears they meant the exchanges only — in which case they’re likely to miss it badly.

In terms of getting more people insured, it might seem like a minor detail. But the private insurance exchanges, a centerpiece of Obamacare, need a very large number of people to sign up if they are to be viable insurance pools. By the Obama administration’s estimate, they need about 7 million people to sign up for the exchanges nationwide. (They also estimate they need 2.7 million of those to be young/healthy types, a separate but related issue.) There is a separate goal of enrolling another 8 million poor people in Medicaid.

Yesterday, The Washington Post suggested that at least 185,000 people have signed up for Obamacare:. That sounds promising for the program even if it’s still well short of the pace needed to meet the goals. And then Oregon has just reported 56,000 enrollments. So isn’t everything going just fine?

In fact, no. When you see state enrollment numbers, you have to ask yourself this question: How many of those people are actually becoming Obamacare private insurance exchange customers, as opposed to people who (1) were always eligible but are just signing up for Medicaid for the first time, and (2) people who are newly eligible for Medicaid under the expanded coverage thresholds in some states?

In Oregon, that 56,000 number you’re hearing today is all Medicaid. Their online exchange doesn’t even work yet. The state bulked up its Medicaid rolls by targeting food stamp recipients. So great, those folks have some kind of insurance (whether or not a doctor will see them), but it tells us nothing about the private health insurance exchanges — the middle class version of Obamacare — or how they’re going to fare.

Something similar is happening in many other states as well. Minnesota, for example, said it had 3,800 applicants. But when you scratch the surface, only 406 of these are Obamacare exchange applicants — again, most of the signups were low-income customers who were steered to Medicaid instead.  

Washington State is Obamacare’s biggest success story so far. But it has only about 3,000 people actually enrolled in the private exchange plans. Nearly 90 percent of enrollees so far are going to Medicaid instead. Although it isn’t completely clear from their confusing presentation of the numbers, it appears they have as many as 25,000 exchange applicants in all, if you include people who have applied but haven’t paid. Even so, that’s half the number people have been bragging about from Washington. So even the best success story is perhaps less exciting than believed. 

California, has put 600,000 new people on Medicaid, but their last hard number of actual, completed applications for the exchanges was under 17,000. That’s over a week old, but I’m still skeptical when I see them say that 100,000 “are in some stage of applying for insurance on the marketplaces.” Why all those weasel words? Have those people completed applications — in which case California is doing great — or have they merely entered their zip code and started looking at plans? California may not release any reliable numbers on their exchange enrollment until next year.

Then there are the real hard cases. Wisconsin had supposedly drawn less than 100 private exchange enrollments — although it will at least be shifting thousands of Medicaid patients into the program, which could give its exchange a better chance at the volume it needs for survival. Colorado had 305 enrollees as of the other day (226 enrollments). Maryland enrolled “more than 1,120″ as of this week. Alaska had supposedly enrolled no one at all — not one person — as of late last week.

Are these numbers going to add up to viable health insurance exchanges? Yuval Levin offered a very sober assessment yesterday on the Corner, noting among other things that the slow trickle of signups, from the insurers’ perspective, is a true nightmare and even worse than if no one was signing up at all. If only “highly motivated consumers” are spending the hours it takes to get through right now, the exchanges are filling up with the people most likely to be very sick or old.

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