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How many people have signed up for private coverage through the ACA?

October 21, 2013

    Dan Diamond, Managing Editor

    We've continued to track applications through the 15 new state-based health insurance exchanges (as you can see from the banner graphic above and at this page).

    And some states are reporting robust early enrollment figures—Kentucky, for example, says that more than 15,000 residents have already been signed up for coverage through its exchange.

    But of those thousands of applications, how many people are being steered toward Medicaid, and how many people are signing up for private plans?

    Most states aren't making it easy to find out the answer, having only released figures on total applications or total number of residents who have picked a plan. 

    However, three states—Connecticut, Minnesota, and Washington—have been transparent over the breakdown between Medicaid and private coverage. And using a memo uncovered by the AP’s Ricardo Alonzo-Zaldivar, we can see how their early progress compares to the White House's original enrollment goals for October in the graphic below.

    Remember, the White House expected that about 7 million Americans would purchase private coverage through the exchanges by March 2014. And based on the AP data, it seems that their "modest goal" was that 7% of those customers would sign up in October, across all the states.

    But also keep in mind: Enrollment takes time. Many people won't end up applying for coverage until deadlines hit and the mandate penalty is looming. (In this case, December 15 and February 15 are the key dates to watch, as NPR's Julie Rovner notes.) That's why officials are expecting a last-minute flurry of interest, given that there's no incentive pushing the uninsured to sign up for coverage now.

    That's what happened when Massachusetts instituted its own health reforms in 2006 and 2007, according to John McDonough, a Harvard professor who helped oversee Massachusetts' reforms and write the Affordable Care Act. The most significant single-month jump in enrollment that first year was December 2007—when the mandate penalty took effect.

    "Bottom line—expectations of large-scale, instantaneous enrollment in the ACA are unrealistic and uninformed," McDonough concludes.

    How do health insurance exchanges work?

    Government officials often compare the exchanges to online travel sites like Expedia or Orbitz. But given that many exchange websites aren't fully functional yet, I find it helpful to picture a big box store.

    For more: Read our primer, or our white paper, for answers to eight key questions and implications for providers.

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