Less Than Half of the States Met their Obamacare Enrollment Targets


In the press release accompanying the administration's Obamacare enrollment report yesterday, Health and Human Services Secretary Kathleen Sebelius declared that the 8 million people who had signed up for private health plans in the law's exchanges had "exceeded expectations." 

That depends on which expectations you're referring to. Looked at nationally, it's true enough, at least if you count sign-ups rather than paid enrollments. The Congressional Budget Office (CBO) had initially expected 7 million people to gain private coverage through the law in 2014, an estimate it revised down to 6 million after the botched launch of the exchanges last of October. As of April 19, slightly more than 8 million had signed up, according to yesterday's report. If you're looking at actual enrollments, on the other hand, and you assume a 15 to 20 percent attrition rate due to non-payment of premiums, then the coverage total drops to somewhere between 6 and 7 million, meaning it beat the CBO's revised expectations but not the initial projection.

But it's also worth remembering that Obamacare enrollment varies quite a bit by state. And some states beat their enrollment projections handily, while others lagged far behind initial estimates. An analysis released today by the health consultancy Avalere Health compares enrollment projections in each state with total reported sign-ups, as well as with a lower figure that factors in a 15 point drop as a result of non-payment of premiums. 

According to Avalere, 22 states met or exceeded enrollment expectations, with the biggest overages appearing in Florida and California, which even after attrition for non-payment hit 199 and 186 percent of their projected sign-ups, respectively. Another four states came reasonably close to hitting their estimates, reaching at least 90 percent of their projected total. Here it is in map form: 

Avalere Health

The rest of the states all came in lower, in some cases much lower, than expected. Attrition-adjusted enrollment in the Distriction of Columnia came in at 40 percent of expected enrollment. Hawaii came in at 46 percent. Wisconsin came in at 57 percent. The figure that stands out the most is New York's attrition-adjusted enrollment, which is just 49 percent of the expected total. That's a bit unexpected considering that New York's existing mess of insurance regulations had decimated the individual market, and that it was one of the few states where Obamacare's rules were almost certain to bring down individual market premiums from their previous highs. (Granted, the state still managed to sign up 370,500 people, more than all but three other states.) 

The report is a reminder is that, especially at first, Obamacare is going to look and feel very different depending on what state you're in. In some places, you'll see robust sign-ups and insurers responding accordingly. In other states, you'll see tiny, struggling markets. Health plan providers are just not going to care as much about doing business in those areas. And, presumably, the politics will be somewhat different in those states as well. 

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  1. “Distriction of Columnia” ???

    1. He was thinking “restriction” and the “fifth column”. A Freudian libertarian slip.

  2. That should probably be “Fewer than Half of States…”

  3. that’s a lot of undocumented patients.

  4. I made the comment to my co-workers that I could take a 20% pay cut and maintain my standard of living if I moved to Texas. I got two reactions, first was generic arrogant splatter towards texans (my co-workers are assholes after all) and the assertation that I would take a 20% pay cut if I moved. So I looked at the actual data. Upstate income distribution skews poorer than all of texas save their worst communities, where we barely tie. We have a greater percentage at the bottom of the gradient, less in the middle and less on top. (Almost as if Blue policies induce poverty).

    So, of course we had a lot of signups in absolute values, we had a lot of people getting subsudies. One more unsustainable government expense. (also, on the gallop poll thread I missed due to work, the reasons people wanted to leave NY were overwhelmingly “cost of living” and “taxes”, trouncing other high exodus states in those being the primary listed reason)

    1. Have you seen this?

      True poverty rates. Cali and NY are both worse than Texas.

  5. The Congressional Budget Office (CBO) had initially expected 7 million people to gain private coverage through the law in 2014, an estimate it revised down to 6 million after the botched launch of the exchanges last of October. As of April 19, slightly more than 8 million had signed up…

    What does one have to do with the other? Even if 6 million, 8 million or 20 million signed up and paid their premiums in no way is that the same as saying these people gained private coverage. Unless we know how many of them were uninsured versus run off their previous plans we know nothing useful.

    1. “What does one have to do with the other?”

      Which shell is the pea under? C’mon, you can do this!

  6. Things are going to get real bad, real fast in the states that 1) have lower than desired exchange signups, 2) have exchange demographics skewing older/sicker than desired and 3) are running their own exchanges.

    The other state and federal exchanges will get real bad, slightly less fast.

  7. Those aren’t enrollment targets, those were just the numbers expected. Since this thing was sold as insuring the 30 million uninsured there were supposed to be in this country, 30 million people would be the actual target. 8 million was the “this thing is such a failure that our actual models predict this will be the number” figure. That’s not a target.

    1. This thing is a failure by pretty much any measure you choose. But yeah, the most important number relative to the rhetoric used to pass the bill is the percentage of the country still uninsured compared to the percentage that was uninsured before the law was passed. Even that comparison would give the law too much credit because the economy was worse off when the bill passed than it is today.

  8. The sign should read:

    “We heart Free Shit”

  9. …”the 8 million people who had signed up for private health plans in the law’s exchanges had “exceeded expectations.””

    After they shoved the goal posts far enough downfield.

  10. Over the mountain and through the woods.


  11. Leave it to Peter to put the worst possible spin on anything to do with Obamacare.

    Even Avalere advertises it as nearly half of all states met or exceeded enrollment goals. But just a tad further delving into the numbers also shows 34 states were within the 80% range of enrollment goals.

    Is that too much of a positive spin? No, it just shows what everyone knew from the beginning, that each state would have varying degrees of success. And as each state moves forward they will learn from each other what works.

    By the way, using New York as an example would have to an example as to how well the exchanges can work, not the other way around. When you include Medicaid, nearly 1M New Yorkers have taken advantage of the ACA, with most estimates saying about 70% of those were uninsured.
    The exchange attracted 16 companies, and premiums have fallen dramatically.

    “Donna Frescatore, executive director of New York State of Health, as the exchange is called, said the state’s decisions had been vindicated by the fact that premium rates had dropped more than 50 percent from previous years.

    Individual premiums for Manhattan residents, for instance, dropped from $1,534 for a standard health maintenance organization, or H.M.O., in 2013 to $621 for a comparable exchange plan now. “I think it has in part ensured that customers have affordable options,” Ms. Frescatore said.”


    1. He already pointed out the fact that NY had a completely broken insurance market due to state regulations. BarryCare actually overrode some of that to make the market functional again. That’s hardly a success story, i.e. government having to fix, um, government.

  12. For NC, I suspect that a large number of sign-ups were people who were getting expensive/crappy private insurance before. Expensive and crappy because of the lack of competition in NC (even employer provided insurance is relatively crappy here because there is no real competition). The vast majority of uninsured folks are still uninsured because Medicaid wasn’t expanded and only children, parents with children living in the home, and adults who qualify as disabled can get Medicaid.

  13. Look over there – not over here! You may see something you like!

    “A new study examining Massachusetts’ 2006 health law reported that a mandatory health care system could indeed save lives. According to the health economists, since the health law was adopted, the state’s mortality rate fell significantly.
    “There is a change happening in Massachusetts that is not happening elsewhere,” study’s lead author, Dr. Benjamin D. Sommer”

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