The ACA

Most Obamacare Enrollees Lacked Prior Health Insurance


How many of the 8 million Americans who have enrolled in health plans through Obamacare exchanges had been previously uninsured? That’s one of several big gaps in our understanding of how the Affordable Care Act is affecting the health insurance market, and the White House helped get us closer to an answer with its latest enrollment update (pdf).

The new data released Thursday tally the entire enrollment period from Oct. 1, 2013, through April, since the original March 31 deadline turned out to be flexible. The information is tucked away in an appendix, and it comes with lots of caveats: Only people applying for subsidies—about 95 percent of those who sought coverage on the federal healthcare.gov marketplace—were asked to report whether they has already had insurance. Of the nearly 5.2 million people who applied for financial help, only about 13 percent had health coverage; 4.5 million had been uninsured before Obamacare.

Officials cautioned that the 13 percent figure for those with previous health coverage is unreliable. “That number, we think, is small,” said Mike Hash, director of the Health and Human Services Department’s Office of Health Reform.

Few of the 16 states (plus D.C.) that created their own exchanges have reported data on this front, but in two cases, the ranks of previously insured are far larger: New York reported that about 30 percent of its 960,000 enrollees (including those joining Medicaid) had previous coverage, and Kentucky reported a rate of about 25 percent. “With that kind of variability, it’s hard to trust any of these numbers,” Hash told reporters on a conference call Thursday.

Another question we’ve been asking: How many people who signed up have actually paid their premiums? People who sign up on a health-exchange website and then fail to pay the insurance company won’t get coverage, so the number of paying Obamacare customers is what we really care about.

Republicans took a stab at answering it Wednesday. A House committee report says that only two-thirds of enrollees in the federal exchange had paid their first month’s premium as of April 15. The committee compiled data (pdf) from 160 insurance companies, including all the insurers selling plans in the federal marketplace.

If only two-thirds of enrollees pay their premiums, that would be bad news for the White House. Still, there are reasons to doubt the GOP’s figure off the bat. People who enroll have weeks to pay their premiums, so not all of the last-minute buyers at the end of March and the late-comers allowed to trickle in past the original deadline into April would have been likely to pay by April 15.

The Obama administration says it doesn’t have firm numbers yet on how many people have paid up, but it points to statements by insurers that suggest a brighter picture. The Blue Cross Blue Shield Association has said member plans saw 80 percent to 85 percent of enrollees pay for plans taking effect Feb. 1, and Wellpoint reported 90 percent.

It may be months yet before we have a clearer picture of how many of the 8 million enrollees followed through to pay their premiums and what proportion of them were uninsured when they signed up.

John_tozzi
Tozzi is a reporter for Bloomberg Businessweek in New York.

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