In a universally sluggish start, just over 100,000 people nationwide selected health insurance plans through new exchanges in the first month of open enrollment under the Affordable Care Act.
But even as critics seized on low enrollment, California’s health insurance marketplace highlighted a surge of more recent activity as evidence that the pace of sign-ups is gaining enough steam to meet projections.
New figures from the Department of Health and Human Services released Wednesday showed that just 106,185 Americans selected health plans through the exchanges from Oct. 1 to Nov. 2. Nearly 75 percent of them, or 79,391 people, signed up through state-run websites that serve 14 states and the District of Columbia.
Only 26,794 people managed to complete enrollment on HealthCare.gov, the troubled federal government website, which serves as the portal for consumers to enroll in insurance plans available through the federal marketplace.
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Millions of customers across the country, meanwhile, are complaining about being dropped from plans that don’t comply with the Affordable Care Act.
Covered California Executive Director Peter V. Lee said the state exchange’s enrollment numbers tell a different story.
“This is a very proud day for Covered California,” Lee said from the agency’s headquarters in Sacramento.
Some 30,830 Californians – representing nearly a third of the national number – signed up for coverage in the first month after the marketplace opened, but the figures showed a large uptick in activity in the first two weeks of November.
Lee, who sought to tamp down expectations throughout October, said another 29,000 signed up through Tuesday, nearly doubling the first-month total.
Both state and federal numbers include people who have selected insurance plans but not necessarily paid their first premiums.
“We’re very pleased with the numbers. We’re very pleased with the momentum,” Lee said. “But mostly we’re very pleased about what this means for the lives of millions of Californians who are going to have health care they can depend on – affordable care that they have not had for many years.”
After initial hiccups, CoveredCA.com has largely recovered from the kind of technical problems that continue to plague the federal enrollment portal in three dozen states.
California estimates between 500,000 and 700,000 customers who are eligible for a subsidy will enroll in the marketplace in the first six months. The state, with about 7 million uninsured residents, is considered a key proving ground for the law.
An estimated 370,000 people initiated electronic applications and 177,331 completed forms through the website, according to first-month numbers released by the state exchange and Department of Health Care Services.
Some 86,000 were determined eligible in the exchange and 72,000 were deemed as likely eligible for Medi-Cal.
The law requires nearly everyone to obtain health insurance or pay a penalty. Customers must enroll in a plan by Dec. 15 for coverage beginning Jan. 1.
“The good news about the California experience with the Affordable Care Act is that there is a huge amount of interest, people are enrolling and they are finding affordable health care options,” said Sen. Barbara Boxer, D-Calif. “At the end of the day, after all the kinks are worked out, I believe the California experience will be repeated across the country to the benefit of our families and our society as a whole.”
In an internal state survey, nearly 70 percent of Californians who completed enrollment during the last three weeks of October found the process easy to navigate.
Glenn Melnick, a health care economist at the University of Southern California, said the lack of sustained or major website snafus makes the state perhaps the best test of the underlying demand for coverage through an exchange.
“I believe California has cause to sing louder than everyone else partly because everyone else is singing a funeral song,” Melnick said.
Still, he said the state exchange must do a better job of speeding up the certification process for thousands of enrollment counselors and insurance agents – particularly to serve individuals and communities less likely to turn to a Web application.
“A big chunk of this population, they are never going to sign up through the Internet,” he said.
“Do they have enough people on the ground, speaking the right languages and helping people understand their options?” he asked. “That part of the campaign has not gone as well as the website has.”
Exchange officials and some health care advocates said they’ve never considered initial enrollment a measure of the law’s success.
Anthony Wright, executive director of Health Access California, a consumer advocacy coalition, likened the latest application figures to watching the early results of a political campaign with just a handful of precincts reporting.
“It’s not a clear indicator of who is going to win the election,” said Wright, adding he was nonetheless pleased to see his state leading the nation.
“I think we can do more to get more enrollment counselors on the ground, streamline the process for organizations to sign up to help, and do more targeted outreach as we get data on where the holes (in enrollment) are.”
A breakdown of demographics, such as the age of those signing up for coverage, should be available at the state exchange’s meeting next Thursday. Enticing enough younger, healthier customers is a crucial element of the law in order to help pay for older, sicker customers.
Back in Washington, officials stressed that the federal enrollment figure was in line with the “very low” numbers Health and Human Services Secretary Kathleen Sebelius projected in recent congressional testimony. Technical problems with the website have frustrated users, as many became stuck and were unable to create the personal accounts required for enrolling in coverage.
In a telephone briefing Wednesday, Sebelius tried to put the best face on the disappointing start.
“The promise of quality affordable coverage is increasingly becoming reality for this first wave of applicants to the health insurance marketplaces,” she said. “There is no doubt the level of interest is strong. We expect enrollment will grow substantially throughout the next five months, mirroring the pattern that Massachusetts experienced. We also expect that the numbers will grow as the website, HealthCare.gov, continues to make steady improvements.”
The White House has sought to lower expectations for weeks. Press secretary Jay Carney said in a briefing before the numbers were released that officials had “fully expected” low enrollment numbers during the first month, pointing to a similar experience with the Massachusetts health care law. But, he said, “The lowness will be exacerbated because of the significant problems with the website.”
The enrollment period for 2014 coverage runs until March 31, but the slow start nationally puts that goal in jeopardy, said insurance industry consultant Robert Laszewski, the president of the consulting firm Health Policy and Strategy Associates in Alexandria, Va. Laszewski expected 40,000 to 50,000 people to enroll on the federal marketplace in October.
He said the lackluster kickoff would be hard to overcome.
“They are in a deep, deep hole, not just in terms of enrollment but in terms of people having confidence in this program,” Laszewski said. “Cynicism over Obamacare has been growing for the last six weeks. There’s really a negative sense in people’s minds for what Obamacare is that they have to overcome here.”
Hoping to head off a congressional revolt, President Barack Obama is considering an administrative fix that would allow people to keep their individual coverage, as well. Carney said Obama’s proposed fix is likely to come “sooner rather than later.”
While an administrative fix might help, Laszewski said the credibility of the health law has sustained long-term damage.
“They’ve got to get Obamacare off Comedy Central and off Jay Leno before they have a chance of succeeding,” he said.