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Making sense of the latest enrollment numbers

November 12, 2013

    Dan Diamond, Managing Editor

    Here in D.C., the health news on Friday was dominated by a surprising Senate release: After one month, just five people had enrolled in the District's new health insurance exchange.

    Maybe most surprised: The people actually running D.C.'s exchange.

    The senators' report was "highly misleading and doesn’t reflect the reality of what’s happening on the ground," Richard Sorian, a spokesperson for DC Health Link, told me by email on Friday. "More than 12,000 residents have created accounts as of [October 21] and 321 went all the way through to pick their plan."

    Who's counting what

    The gap between the Senate and DC Health Link's numbers gets to the nuance of tracking early sign-ups through the new insurance exchanges:

    • The senators' figures drew on how many residents had paid their premiums two months before the plans kicked in, Sorian said. And the data came directly from participating insurance companies, who said they'd only received a handful of enrollments from DC Health Link.
    • But D.C.'s exchange, like most exchanges, is reporting the number of people who have selected a plan, if not necessarily paid for it yet. And DC Health Link won't send an 834 file to an insurer until a payment has been made, Sorian told me.

    Parsing the enrollment data has been an especially tricky calculation, especially this week, when it feels like sign-up figures are dominating the headlines.

    The Wall Street Journal is reporting that slightly less than 50,000 people have used healthcare.gov to enroll in private plans. Additional analysis suggests that more than 40,000 people have used the state insurance exchanges to buy private coverage.

    Here's how we're thinking about it, on the Daily Briefing: We're looking at total enrollment, with an eye on the difference between Medicaid and private plan sign-ups. And as part of that effort, we're tracking the number of people who have picked a plan (if not necessarily paid for it yet).

    Total enrollment: We've been tracking what state officials have reported on residents getting new coverage through the exchanges--residents who have either enrolled in Medicaid or picked a private plan. Here's our latest count through Tuesday morning:


    Monitoring total enrollment through the exchanges is a useful barometer of interest in the new marketplaces, with clear downstream effects for providers--several executives told the Daily Briefing that they're keeping an eye on whether the exchanges will end up delivering expected volumes in year one, especially given the ACA's cuts to Medicare and Medicaid reimbursement.

    But it's also been useful to track the difference between sign-ups in private coverage and enrollment in Medicaid. (Here's some more context on that distinction.) And the balance remains heavily tilted toward Medicaid expansion; as of Tuesday morning, we'd also seen more than 40,000 people using the state exchanges to purchase private coverage.

    Note: Very close observers of the recent enrollment reports will notice that we haven't counted the 82,000-plus Maryland residents who were signed up to be auto-enrolled in the Medicaid expansion on Jan. 1. Why? That program is separate from the exchanges (and among several states' efforts to take advantage of an early opportunity to expand Medicaid).

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