Interpreting HIE Enrollment Numbers

CMS reported on March 11, 2014, that enrollments in the national health insurance exchanges (HIEs) have reached 4.2 million individuals, with 20 days until the enrollment deadline. While this number is not close to the originally targeted 6 million enrollees, the administration is touting this as a successful achievement. The CMS numbers have already been analyzed and interpreted from many different angles.

Critics of the new law are still awaiting the final demographic data to be released to see if the enrollees in the exchange plans are indeed the young and healthy individuals that were predicted by the administration to make up the majority of the enrollees. According to the CMS report, only 25% of the 4.2 million enrollees are between the ages of 18 and 24 years old. Young people make up approximately 40% of the nation’s uninsured population so critics are quick to point out the significant shortfall there. There is potential for a hidden benefit in the report for payors: a slightly older, healthy population who would not utilize health services much more than the younger population would cost less in terms of utilization, but likely pay higher premiums based on age.

McKinsey, a leading management consulting firm, has been conducting monthly surveys of the exchange-eligible population and providing informative data regarding the enrollee population vis a vis the exchange plans. The reports from McKinsey offer more interpretation of the available data, combined with proprietary survey data.

McKinsey’s most recent survey, conducted in February 2014 with 2,096 eligible respondents, found that only 48 percent of respondents had thus far signed up for a 2014 health plan. Within that 48 percent, three-fifths were previously insured people who liked their old plans and were able to keep them under the new law. The remaining two-fifths were the ones who signed up for coverage on the exchanges. Of those in the survey who opted not to sign up for coverage under the exchange, affordability was the leading reason cited for not enrolling, a surprising 50%, which serves to question the “affordable” part of “Affordable Care.”

Last fall, the Associated Press reported that 4 million individuals had their coverage canceled or interrupted because their plan did not meet the requirements of the new law. Many of these people then enrolled in the exchanges, frequently with higher premiums, likely linked to cover the cost of coverage expansions under the new law.

The new CMS report does not indicate how many of the 4.2 million HIE enrollees were previously uninsured.