Wednesday, October 01, 2014

ACA Signups: "Over 9.5 million served"?*

Charles Gaba has been tracking ACA enrollments during the off-season, as he did during open season. He estimates that approximately 9,000 people per day are signing up for private plans via "special enrollment" periods, with net attrition of about 2% per month as people drop plans for a variety of reasons.

Tonight Gaba estimates that there have been about 9.5 total private plan (QHP, for Qualified Health Plan) signups to date That's a number that most people will mentally offset, as HHS recently announced that about 7.3 million are currently enrolled in QHPs. Perhaps a bit less than half of that 2.2 million difference is comprised of people who never paid, the rest dropping plans at various points.

It's natural and to a degree fitting to focus on the number of current enrollees. That number is important in that a) the ACA has a long way to go to full takeup -- CBO forecasts 25 million exchange users by in 2018 --  and b) the states' risk pools need to maintain critical mass to establish a viable market. Still, the total number served since the outset -- discounting, perhaps, most of those who never paid -- is also significant.

Churn in the individual insurance market is not only longstanding and inevitable, it's integral to that market's primary function, which is to serve as a stopgap. That may change over time, if the ACA triggers a transition away from employer-sponsored insurance, but for the foreseeable future 150 million-odd accessing ESI will dwarf 15-25 million in the individual market. And as long as that's the case, probably half of those who enroll in QHPs will stay enrolled for less than a year.

But those who stay enrolled for just three or six or nine months are still beneficiaries. Someone who loses a job and finds another one with insurance six months later (perhaps kicking in after three months of employment) may save a few hundred or a few thousand dollars accessing a subsidized ACA plan instead of COBRA.  For another, the ACA may spell the difference between being insured or uninsured during the unemployment spell, short or long.  Ditto for those newly divorced and either unemployed or employed without ESI.

My point is simply that the ACA marketplaces have helped many of those already out as well as those currently in -- and the former will eventually far outnumber the latter. As with McDonalds hamburgers, the total number served is as noteworthy in its way as the number currently eating.

* Given the million-odd who never paid a premium, let's call it 8.5 million.

Update, 10/2: If I'm right that about 8.5 million have benefited from the ACA private plan marketplace, someone tell CMS's Marilyn, who told NPR yesterday:
In a six month period, we probably, you know, did something that hadn't been done before. And 7.3 million Americans have benefited from that and we look forward to year two and having more Americans benefit from this type.

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