Obamacare Sign-Ups: What The Numbers Mean

Jan 14, 2014

Here's a sampling of headlines from the past two days about the latest Obamacare exchange enrollment numbers (thanks to Kaiser Health News for rounding these up):

The New York Times: Older Pool of Health Care Enrollees Stirs Fears on Costs
Los Angeles Times: More Than 2.1 Million Sign Up For Obamacare Health Coverage
Kaiser Health News: Nearly A Quarter Of Health Marketplace Enrollees Are Young Adults
The Washington Post: Health-Insurance Sign-Ups By Young Adults Are Off Pace Seen As Key To New Law’s Success
The Wall Street Journal: Health Sign-Ups Skew Older, Raising Fears Over Costs
The Associated Press: Health Care Signups: More Older Americans So Far
USA Today: Most Insurance Enrollees Older Than 45, Records Show
Politico: Young Adults Make Up One-Fourth Of Obamacare Enrollees
CBS News: Obamacare Sign-Ups Among Young Adults Off To Slow Start
Fox News: Insurers Raise Cost Concerns After ObamaCare Demographic Data Released
McClatchy: Young Adult Enrollment In Health Care Marketplaces Lags
Marketplace: Obamacare Stats Show Young Folks Are Signing Up
The Fiscal Times: Four New Mysteries in the Obamacare Enrollment Numbers
The Fiscal Times: White House Claims It Will Reach Obamacare Goal
CQ HealthBeat: HHS Optimistic About Exchange Sign-Ups Among Young, But Enrollment Still Key

So, some emphasize the number of older enrollees, some highlight the optimism about expanding the number of younger enrollees. And mostly, they're talking about federal health insurance exchange sign-ups.

In Rhode Island, which has its own state-based exchange, HealthSource RI, the numbers are similar, though a little different. As of Jan. 4, according to HealthSource RI, just over 3400 Rhode Islanders 34 and under had enrolled in a plan. Just over 8300 over that age, many of them 55 and older, had enrolled. These numbers don't count the nearly 20,000 Rhode Islanders who have newly enrolled in Medicaid.

So what's the big deal? Why so many headlines?

Well, as to the latter, it's no surprise every twist and turn in the Obamacare rollout generates coverage, because it's President Barack Obama's signature program, and there are constant efforts to defund it based on its success or failure. Plus there's lots of money involved, and many stakeholders.

As for why the age of enrollees matters - especially to people who already have health insurance through their job or otherwise - that's a bit more complicated. The big idea is that the more healthy people in an insurance plan, the lower the cost to that insurer, and, theoretically, the lower the insurer can make costs for everyone on that plan. But does it always work like that, so straightforward, and so quickly?

Based on my conversations with sources, the answer is yes and no (isn't it always?).

Insurers in Rhode Island  must submit rate requests every year, and they have to demonstrate why they want an increase. That's based, in part, on "claims experience" for the past year, which is how much money they paid to doctors and hospitals, etc., on behalf of their members. Lower claims experience should mean lower rates, right? But insurers have been telling me that health care costs in general are going up. Also, they're responsible for covering some different things under Obamacare - some may be new offerings, some they may already have been covering for a while.

The question for me is whether the experience of enrollees in plans on health insurance exchanges will ripple out and affect what we all pay for insurance. That's not clear now and won't be for a while.

But there are other efforts underway to address the cost of insurance, including several in Rhode Island that we've covered here. Experiments in paying doctors to keep patients healthy, rather than per service, attempts to coordinate the care of patients with chronic illness, and others may help bend the cost curve.

So that's my lay person's assessment of why the numbers matter. There are far better experts than I out there, and if you've got a different take, I'd love to hear it.