Understand how we got here — and how to move forward.

Blog Post

Exchanges steer volumes to large plans—and small plans with low prices

January 15, 2014

    Dan Diamond, Managing Editor

    A few years ago, Slate's John Dickerson suggested that the Obama administration loved making—and breaking—deadlines, whether delaying its plans to close the Guantanamo Bay prison or fill open judicial seats.

    President Obama, Dickerson wrote, had "a professor's fondness for deadlines, and a writer's lack of respect for them."

    Perhaps fittingly, the president's signature health law also has been marked with deadlines—and a general lack of abiding by them.

    Back in 2009, the White House set multiple deadlines for Congress and its committees to pass health reform legislation. (Lawmakers mostly missed them.) Throughout the ACA's implementation, HHS and other agencies were given or issued dozens of statutory deadlines. (About half didn't stick.)

    Some Obamacare implementation delays have gotten plenty of press coverage, in the Daily Briefing and elsewhere, for their political and practical ramifications. One that was greeted with more of a shrug? The decision to push back the Dec. 15 deadline to sign up for insurance plans that start on Jan. 1, 2014. California first announced an eight-day delay in late November, and other states and the federal exchange quickly followed.

    But that deadline extension, which was initially seen as a workaround for the exchanges’ technical glitches, has emerged as a pretty canny move. In the states where data's available, hundreds of thousands of Americans took advantage of the extra week to sign up for coverage.

    Whether an indictment of the exchanges’ initial bugginess—or the inherent procrastination when shopping for health insurance—more people appeared to sign up for Obamacare coverage in the last week than in the exchanges’ first month.

    • At least 6,600 residents of Connecticut signed up for private plans and Medicaid through the exchange on Monday, Dec. 23—"by far the biggest day we've ever had," according to the CEO of Access Health CT, Arielle Levin Becker reported for the Connecticut Mirror. (In comparison, about 7,600 Connecticut residents enrolled for the entire month of October.)
    • More than 100,000 Californians picked a private plan in the four days between Dec. 20 and Dec. 23, a Covered California spokesperson told me—almost as many as the 109,000 shoppers who signed up during October and November combined.

    It's impossible to know if customer behavior would have been radically different had the deadline stayed Dec. 15. Shoppers already were starting to turn out in droves in early December, and Parkinson's Law—the notion that your work always expands to fill the time you have—suggests an inevitable surge, whether the final day to pick plans was December 3rd or 23rd.

    As the New Republic’s Jon Cohn and others have pointed out, shopping for health insurance takes time and observers needed to be patient for purchasers to make their decisions. Survey data from the Morning Consult and elsewhere suggested that most would-be customers always planned to return.

    But the enrollment spikes in early December pale next to the surge that came later in the month. And it does seem that the week-long delay offered flexibility and awareness benefits, such as giving insurers and federal officials more time to run ad campaigns, even while retaining the most valuable aspect of a deadline: Forcing people into making a decision.

    The deadlines yet to come

    There are still important deadlines to hit; many of the 2 million or so people who have signed up for coverage that takes effect on Jan. 1 haven't paid their first month's premium yet. There are still open questions about whether sign-ups have been fully captured and successfully transmitted to insurers, and if payers have enough time to make sense of this flood of new enrollments.

    And it's worth remembering: This week's deadlines were only to purchase plans that take effect in January. There are still three more months before Obamacare's first open enrollment period ends.

    "Might be more accurate to refer to January 1 as the first OPPORTUNITY to get ACA coverage," Larry Levitt of the Kaiser Family Foundation tweeted earlier this week. "March 31 is the real DEADLINE."

    Have a Question?


    Ask our experts a question on any topic in health care by visiting our member portal, AskAdvisory.