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The difference between 'picked a plan' and 'enrolled'

October 30, 2013

    Dan Diamond, Managing Editor

    HHS Secretary Kathleen Sebelius told a House committee on Wednesday morning that her agency can't offer a picture of early enrollment through the health insurance exchanges, because officials (and insurance companies that particpate in the exchange) still lack accurate data.

    Sebelius is pointing to a key nuance that we've found when doing our count--which draws from on-the-record reports from state officials, to be clear.

    While at least 150,000 people have used the 15 state-based exchanges to pick a plan, many of those people aren't technically "enrolled" in coverage. Why? Three key reasons.

    • Because these customers haven't paid their first-month premium yet.
    • Because many states haven't transmitted the crucial "834" forms, which contain customer data, to the insurance companies.
    • Because most of the 834 forms that are being sent to insurers are still riddled with problems, requiring hands-on fixes before customers can be entered in their systems.

    That's why we made sure to call our column "picked a plan/enrolled," to capture a broader picture of total sign-ups for coverage. Here's our latest quick state-by-state look, as it stood on Tuesday afternoon.

    As of Oct. 30, we'd counted at least 150,033 people who had used the state exchanges to pick a plan or obtain new Medicaid coverage:

    But a closer look reveals that in states that have reported a specific breakdown, the balance remains heavily tilting toward Medicaid. Again, as of Oct. 30, at least 109,818 of those 150,033 enrollees had signed up for Medicaid or other public programs.

    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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