About 40,000 Americans Are Said to Have Signed Up for Plans on HealthCare.gov

By Amy Goldstein and Sarah Kliff, The Washington Post

12 November 13

oughly 40,000 Americans have signed up for private insurance through the flawed federal online insurance marketplace since it opened six weeks ago, according to two people with access to the figures.

That amount is a tiny fraction of the total projected enrollment for the 36 states where the federal government is running the online health-care exchange, indicating the slow start to the president's initiative. The first concrete evidence of the popularity - and accessibility - of the new federal insurance exchange emerged as the White House has been preparing to release this week the first official tally of how many people have chosen coverage using the Web site, HealthCare.gov.

One administration official said Monday that the official figure will include people who have paid for a health plan and those who simply picked a plan and put it in their online shopping cart.

The administration's only known previous projections come from internal memos, released on Capitol Hill, that predicted that about a half-million Americans would have selected insurance by the end of October. It was unclear whether that figure, cited in a letter last month by House Ways and Means Committee Chairman Dave Camp (R-Mich.), included only people who enrolled in private health plans or also low-income people who joined Medicaid.

The figure of 40,000 disclosed Monday did not include Medicaid sign-ups. At least 440,000 people have signed up for Medicaid through the health-care initiative, according to Avalere Health, a consulting firm that has been tracking sign-ups. Budget forecasters have projected that in 2014 there will be a much more even balance between private insurance and Medicaid participants.

In recent days, officials inside the White House and at the Department of Health and Human Services have been working to dampen public expectations for enrollment, in light of a rollout of the online marketplace that they have acknowledged has been disastrous. HealthCare.gov has been riddled with hardware and software problems that have stymied many Americans trying to shop for or purchase a health plan.

"I can tell you our early enrollment numbers are going to be very low," HHS Secretary Kathleen Sebelius testified last week before a Senate committee.

According to one person with knowledge of the figures, slightly fewer than 40,000 people had selected a health plan as of last week. The figures are derived from reports that the government sends to each participating insurer early every evening, letting them know which customers have signed up that day. The figure was first reported Monday by the Wall Street Journal.

White House and HHS officials declined to confirm the 40,000 figure. HHS spokeswoman Erin Shields Britt reiterated what has become the administration's talking points in recent days. She noted that the exchange's technical problems have hindered enrollment - and that sign-ups also were slow when Massachusetts several years ago became the first state to run a similar insurance exchange.

Those 40,000 people live in 36 states that are relying on the federal insurance exchange to provide new health plans as part of the 2010 Affordable Care Act.

In comparison, 14 states and the District are operating separate exchanges, and an analysis released Monday by Avalere shows that about 49,000 people have signed up for coverage in those exchanges - representing about 3 percent of the eventual expected enrollment in those states. Although the state exchanges have varied in how easy they are to use, few have been marred by technical problems as severe as the federal HealthCare.gov. Of those exchanges, the District has had the smallest proportion of anticipated insurance-seekers sign up, with 300 people - or 1 percent - enrolled as of the end of last week. Richard Sorian, a spokesman for DC Health Link, said that "most people do not have the luxury of paying for coverage in October, months before a bill is due." The analysis, however, includes people who have picked a plan but not yet paid for it.

The federal figures reflect the earliest - and in some cases, most persistent - of the Americans who have a six-month open-enrollment period, ending March 31, to buy insurance through the online federal marketplace. This exchange is intended primarily for people who do not have access to health coverage through a job, many of whom will be able for the first time to get government help in paying for insurance.

Under the health-care law, most Americans will be required to have insurance, and people who have not purchased any by the end of March will face financial penalties. The new insurance will take effect Jan. 1 for those who sign up by mid-December.

The Congressional Budget Office has estimated that 7 million Americans will gain private coverage through the federal exchange and state exchanges by spring - and 22 million within a few years.

A spokesman for the insurance industry's main trade group said the slow early enrollment does not matter as much as how many sign up by the spring. "That's what will determine how well these reforms are going to work," said Robert Zirkelbach, spokesman for the group America's Health Insurance Plans.

The insurance industry has a substantial stake in who enrolls, as well as how many do so. Unless enough young, healthy Americans sign up, the cost of coverage is likely to escalate - in turn, discouraging people from getting or keeping coverage.