Obamacare's Weak Enrollment Numbers

Health law exchanges face 25 percent attrition rate in 2015.



The primary talking point for Obamacare supporters these days is that the law has facilitated a significant reduction in the nation's uninsurance rate. The percentage of uninusured in the United States dropped down below 12 percent last year, its lowest rate in years and a five point drop since Obamacare's coverage expansion provisions kicked in, according to Gallup. And the law's health insurance exchanges, one of its two key coverage expansion mechanisms, along with its expansion of Medicaid, has played a significant role in making that happen. Enrollment in exchange coverage increased from 6.3 million at the end of 2014 to about 8.8 million, according to figures released by the administration at the end of last week.

But Obamacare's coverage gains have also been more modest than expected, particularly when it comes to the exchanges. And part of the problem seems to be that people who sign up for coverage at the beginning of the year don't always follow through to keep their coverage effective at the end of the year. It's a problem that seems to be larger than the administration knew.

Overall, exchange enrollment is short of where the Congressional Budget Office initially expected it would be by roughly 7 million people. And although the 8.8 million enrolled in the exchanges at the end of 2015 is a notable step up from the 2014 numbers, it's also below expectations: The administration had targeted a figure of about 9.1 million, but came up short. And even if enrollment had come in at the administration's target, it still would have represented a significant drop off from the 11.7 million people who signed up for coverage at the beginning of the year. The point is, there was a 25 percent decline from the number of people who were signed up at the beginning of the year to the number of people fully paid and still enrolled at the end of the year.

What's happening, basically, is that attrition is turning out to be even larger than expected. And while it's not entirely clear why, there are certainly some good indicators.

As the administration noted in its press release last week, coverage for a half a million people was terminated in 2015 because of what the administration is describing as "data matching issues"—essentially, their citizenship, immigration, or other personal info didn't match up with federal records. They couldn't prove they actually qualified for coverage under the law.

There are also a lot of people who appear to be signing up but never paying for coverage at all. Brian Blasé of the Mercatus Center suggests that this accounts for about half of the decline. Blase also points to a New York Times report from late last year suggesting that many people don't find their coverage all that valuable once they try to use it.  In addition, as Jed Graham points out in Investor's Business Daily, the enrollment data released last week suggests that the law is placing burdens on middle and working class Americans, sometimes forcing them to choose between buying coverage that isn't helpful and paying a penalty to remain uninsured.

These disappointments go a long way toward explaining the persistent negative-tilt to public opinion about the law, and why even its most ardent defender in the presidential race, Hillary Clinton, has consistently said the law needs to be fixed and improved upon, particularly when it comes to personal expenditures.

In the sense that it has improved coverage rates, then, Obamacare may be a success, though a more modest one than many had hoped. But to a lot of people, it clearly doesn't feel that way.

NEXT: Yes, the GOP Can Change Its Trump-Helping "Eight-State" Rule. But It Missed a Chance to Do So Without Obviously Slapping Trump in Face.

Editor's Note: We invite comments and request that they be civil and on-topic. We do not moderate or assume any responsibility for comments, which are owned by the readers who post them. Comments do not represent the views of Reason.com or Reason Foundation. We reserve the right to delete any comment for any reason at any time. Report abuses.

  1. coverage for a half a million people was terminated in 2015 because … [t]hey couldn’t prove they actually qualified for coverage under the law.

    That’s outrageous! They don’t have to prove they’re actually qualified to *vote*!



    How is that working for ya?

  3. The percentage of uninusured in the United States dropped down below 12 percent last year, its lowest rate in years and a five point drop since Obamacare’s coverage expansion provisions kicked in, according to Gallup.

    this is close to meaningless unless you divide the Medicaid expansion from the health insurance exchanges, and account for any growth in the workforce.

    By the time you subtract growth in the workforce (who presumably would have been covered sans OCare) and the Medicaid expansion, I’m willing to bet that the net increase in people covered via the exchanges is minuscule. Don’t forget; @ 5mm people were kicked off of their policies when OCare went into effect, so the first 5mm of exchange policies are catchup.

    1. Most of the people whose policies were cancelled in 2013 signed up for new policies in the off-Exchange ACA-compliant non-group market (as the vast majority of subsidy-ineligible people still do). According to industry filings, the total non-group grew by over 8 million people (12M to 20M+) between Q4 2013 and Q1 2015.

      Gallup excludes the over-65 population in its estimates. The total uninsurance rate in 2015 (Q1-Q3) is more like 9%. That is 6 percentage points lower than the average during the non-recession Bush years, which represents almost 20 million fewer uninsured than one would expect under pre-ACA law.


      1. “Most of the people whose policies were cancelled in 2013 signed up for new policies in the off-Exchange ACA-compliant non-group market ” and are paying 30-50% more for crap coverage.

        1. You are welcome to produce some evidence. What was the average premium for major medical insurance (with no condition waivers) in the individual market in 2013 for, say, a 40 year old female? Or a family of four? What is it now?

          1. You are welcome to go to hell. My premiums have gone up consistently, and are now about 50% higher than before. Opening insurance markets across state lines, without the exchanges, would have been a much better solution than this bloated piece of crap legislation.

  4. Universal love for higher deductibles and crappier coverage?

  5. m seems to be that people who sign up for coverage at the beginning of the year don’t always follow through to keep their coverage effective at the end of the year.

    I walked away from my ACA coverage and have been tossing the bills in the shredder. I’m a conscientious objector.

    1. As I shall be doing probably next year.

  6. There were 12.7M people who signed up in the latest enrollment period, an increase of 1M from the same period last year.

    The key is how many are in the 18 to 34 age group, and that was about 28%. The goal is about one third. And that number is rising.

    But you say it may be a success based on certain measures. I’ll take it. That’s a far cry from when you said the number of uninsured wouldn’t improve, the system would never work, and the young would stay away.

    And in the meantime, we’ve moved away from “repeal” to “repeal and replace,” a tacit admission that putting the millions of people who gained insurance back into uninsured category just won’t cut it.

    1. Well, if we simply ask ourselves “are more people insured” you might be able to stretch and say that the ACA is working. If you ask if healthcare costs have been controlled, the answer to that is an unequivocal “no”. Every company in existence that’s trying to provide insurance to its employees is facing dramatically rising premiums, to the point where those companies either have or are considering dumping their coverage and forcing people into ACA plans.

      1. As I recall that was their measure of success: More people who are technically covered. They paid lip service to cost control, but everyone and their dog knew that wasn’t going to happen since we already saw the result of both Medicare and Medicaid. That was never in the cards at all and everyone knew it.

        Of course, even if it was actually successful at cost control I’d love to hear more about how 250,000 doctors are supposed to actually see all 300+ million U.S. citizens. Or why anyone in their right mind would spend something to the tune of 12 years in school to make a government salary.

        Oh, actually I know the answer to that last question. It’s because they’re selfless and giving human beings right? Of course, if that was actually true none of this would have been necessary in the first place.

        1. The answer is that you have a gov-given right to healthcare – their services. Those docs, nurses, and staff cannot refuse services. They are your bitches…er …slaves ..servants…whatever.

      2. The ACA has had no reliably demonstrable affect of health care price inflation one way or the other yet, so if you wish to call that a failure that’s your privilege. That said, it is incontrovertibly false to claim that “every [or even most] companies in existence are facing dramatically rising premiums”. Between 2000 and 2010 ESI premiums grew at an average rate of about 8% p.a. Since then, the growth rate has dropped to about about 4%. (The reason we can’t attribute that to the ACA is that premium inflation started to slow before the ACA became effective law).

        As an aside, it’s interesting that you mention the prospect that companies “either have or are considering dumping their coverage and forcing people” into the non-group market. The most significant factor in Exchange enrollment not meeting CBO projections is the fact that that there has been no noticeable “dumping” effect yet (they expected 6M by now).

        1. Of course if you tell them that the rate of health care cost inflation is at HISTORIC lows, their response would be “you can’t prove it was due to Obamacare.” Even though it strangely responds to its introduction.


          1. *corresponds.

          2. I was being cautious. The Great Recession had an effect, and it is too early to expect most cost-cutting experiments in the ACA to have had much impact yet. I’m still hopeful, however.

            1. Or you have people like me, who can’t afford the price of copays and the cost of getting to their deductible limit, and to live. I just had my first doctor’s appointment in 3 years recently, and hopefully only need to go once a year, and have zero other health costs, since my coverage has been eroded by Obamacare’s mandates, and my options outside of my employer’s coverage have quadrupled in price. Thanks Democrat party, and all proggie assholes who vote for them!

            2. And of course, if Hillary wins, I fully expect that at some point, her administration will try to identify its enemies through the websites they browse, and the comments they make on various issues, and attempt to deny them healthcare. That is the key problem with healthcare controlled fully by government fiat. Even if my plan is through a private insurer, their profits are so tied into government regulation and spending that if I manage to piss off the wrong person, I will lose my healthcare.

        2. I have no doubt that the ACA will ultimately lower healthcare prices (not costs).That was a major goal. However, lowering prices via price fixing limits supply. And this takes time a little time to manifest. Obama will be long gone and the blame will be affixed to a whole new administration that had nothing to do with this trainwreck.

          The next big crisis in healthcare will be the shortage of specialists and it will be blamed on greed. But the real reason is, of course, price fixing by the ACA.

          1. Do you have any data that supports your prediction? Less students enrolling in medical schools? Number of doctors in the country declining? American doctors leaving the country to work elsewhere?

            1. It’s called the Law of Supply and Demand.

              My own doctor stopped taking medicaid and medicare. There are stories about similar happenings regarding ACA. Unitedhealthcare is mulling over getting itself out of ObamaCare. You do the logic. When doctors are paying their staff more than they get reimbursed, they will close their practises. Most thinking people don’t require data and graphs to figure this one out.

              1. I get the theory. And if the demand is high, the supply increases to meet that demand. Because there is money to be made.

                But I’m still interested if you have any data that supports that thought. The ACA has been in existence for 5 years now.

                1. You know, I guess if you call this success, I’d hate to see failure:

                  400,000 Citizens To Lose Health Insurance (Again) Because Of Obamacare Co-Op Failures

                  The two largest state health insurance co-operatives created as part of a grand ObamaCare experiment have announced they are closing at the end of this year, joining others that have failed and even more that are insolvent and likely to fail.

                  The Kentucky Health Cooperative announced on Friday it is going out of business and will not enroll new members next year, leaving 51,000 members to find other coverage. It had the second-largest co-op enrollment in the country, garnering 75% of people who enrolled in coverage through the state’s health exchange.

                    1. Glad to see your concern that 400k lost their insurance. You must have been elated when millions gained insurance under the ACA. The good news for the 400k is that they have more choices.

                      It’s a marketplace. No one ever said all the exchanges would work.

                2. I get the theory. And if the demand is high, the supply increases to meet that demand. Because there is money to be made

                  No. It doesn’t. Because of the price controls that are sure to come, there will be no incentive to increase supply. That’s the problem.

                  1. And yet…the ACA has been in existence for 5 years. Millions have gained insurance and are seeing doctors. You would think you might have solid numbers on a shortage of doctors now.

                    And yet…enrollment at medical schools has increased 30% as well.

        3. The ACA has had no reliably demonstrable affect of health care price inflation one way or the other yet, so if you wish to call that a failure that’s your privilege.

          Anthem, the largest seller of small-business health insurance, lost almost 300,000 members in such plans ? many more than expected ? in the first nine months of the year. That was 15 percent of the enrollment. Many of those consumers are presumably switching to individual plans sold through exchanges, including those offered by Anthem, officials said.

          Also, you don’t even acknowledge the likelihood of second order effects, such as companies that fall just under the Obamacare mandate shutting down growth and investment because once you cross the line, your exposure to healthcare costs change dramatically.


          That’s a problem for all employers. At a 5% average premium increase after plan design changes, employers are still facing rates “well above inflation,” said Steve Wojcik, NBGH’s Washington-based vice president of public policy.

          “Health care costs are going up much faster than other costs for the company,” he said, and “faster than they can generate revenue.”

          1. ..contd

            Currently, I don’t KNOW anyone working for a company that hasn’t seen significantly higher premium rates. Our company just had its 4th quarter meeting and as per usual, premium rates and the cost of insuring the company’s employees was brought up– it’s always a major concern.

            As BYODB mentioned above, we all kind of know that cost-cutting was a *wink*wink*nudge*nudge* that even the Obama administration didn’t believe.

            As you fairly point out below, the Great Recession was seeing a slowdown in rates, and if we take that seriously, it’s very likely that Obamacare has had no success on its stated goal of lowering healthcare costs.


        4. Blah blah blah blah blah blah blah.

          You know what? It doesn’t matter. It doesn’t matter what metrics to use to talk about what, because it’s still the government forcing you to purchase a consumer good, and that will ALWAYS be bullshit.

  7. One troll so far. Who’s next? Step on up!!

  8. Holy cow man why didnt I ever think of that.


Please to post comments

Comments are closed.