7 Takeaways From the New Obamacare Sign-Up Data



The Obama administration released another round of data on Obamacare insurance sign-ups yesterday. The report covered plans selected in both federal and state-run exchanges through December 28. Some of the information in the report had already been released, such as the total number of sign ups. The report did, however, contain the first official federal government data about the age breakdowns of those who have signed up for plans so far. Yet even with the new information, the report also left a lot of important questions unresolved.

Here are seven takeaways and unanswered questions from the latest sign-up data.

1. The percentage of young people who have signed up so far is below the administration's target. As was expected based on preliminary statements by insurers and some state-level data, the percentage of young people who have signed up for private plans in the exchanges so far is low. Administration officials have indicated in the past that they need between 38 and 40 percent of private plan enrollees to be between the ages of 18 and 34 to make the new insurance risk pools sustainable. Premiums paid by that relatively health age group are needed to balance out the costs of older, and more expensive to insure, beneficiaries. 

But across the federal and state exchanges, just 24 percent of enrollees so far are between the ages of 18 and 34. That's well below the target, and out of proportion to the overall age makeup of the uninsured, about 40 percent of which are young adults. The administration notes that enrollment amongst the young was up in December, and says they expect that most young and healthy enrollees will sign up in March, at the end of this year's open enrollment period. But the lower than expected enrollment amongst the young so far isn't a good sign, and suggests that insurers may take a hit on plans offered in the exchanges this year. 

2. Every market is different, and some are worse off than others. Overall, the young made up about 24 percent of enrollees in private coverage through the exchanges. But the percentages varied by state. In Ohio, for example, just 19 percent of enrollees were between the ages of 18-34, while in New York, 27 percent of sign-ups were in that age group. There were also big differences in sign up numbers. Texas, the state with the second highest population, has recorded just 118,532 sign-ups so far, while North Carolina has 107,778. What this suggests is that going forward, there will be big state-by-state differences in the health of Obamacare's insurance markets. The exchange plans may prove sustainable in some places, but crash and burn in others.

3. Private plan sign ups so far are widely subsidized. Nearly 8 in 10 sign ups so far have been for subsidized coverage, with 78 percent of plans in state-based exchanges qualifying for financial help and 80 percent of federal sign-ups qualifying.

4. More women are signing up for coverage than men. About 54 percent of sign ups across both state and federal exchanges so far are from women. Since medical insurance tends to be more expensive for women, and the law prohibits price discrimination based on gender, this also suggests that the sign-ups through the end of last year were weighted toward those with higher medical bills.

5. We still don't know how many people have actually paid for private coverage. All of these figures are for people who have signed up for coverage. Some of them have paid their first month's premium, but some of them have not. Insurance companies have extended payment deadlines for coverage beginning in 2014 to at least January 10, and in some cases beyond that, which suggests that many have still yet to pay. But at some point, the extensions will have to stop, and we'll find out how many of those who signed up for coverage actually paid a premium and ended up fully enrolled.

6. We still don't know how many Medicaid enrollees are new and how many are simply renewing existing coverage. At the beginning of a press call yesterday, Health and Human Services Secretary Kathleen Sebelius touted the 3.9 million people the federal government says enrolled in Medicaid during October and November of last year. But some number of those people, perhaps the large majority of them, aren't getting coverage because of Obamacare's Medicaid expansion. Instead, they are renewing existing Medicaid coverage. Federal officials say they don't have a breakdown of how many of those 3.9 million Medicaid enrollees are new, and how many are just extending coverage they already had.

7. We still don't know how many people signing up for private insurance were previously uninsured. Even if you ignore payment issues and count all 2.2 million private plan sign-ups as being enrolled, we still don't know how many of those people were previously covered, and how many already had some form of health insurance. Given that Obamacare was chiefly sold as a vehicle for expanding health coverage, that's a pretty important figure. Without it, we really have no idea how many previously uninsured people have gained coverage under the law, and how many have simply shifted to different coverage under the exchanges.