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Latest ACA enrollment numbers lower than expected

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ACA enrollment in New Jersey is far lower than expected, with just six weeks left until the March 31 deadline.
ACA enrollment in New Jersey is far lower than expected, with just six weeks left until the March 31 deadline.

About 3.3 million Americans, including 54,805 New Jerseyans, have enrolled in the new Health Insurance Marketplace of the Affordable Care Act through Feb. 1. And although there is still more than a month left before the March 31 deadline, those numbers still fall well below expectations.

Some estimates last fall indicated more than 700,000 Jerseyans were eligible to sign up through an exchange — with 300,000 others eligible to sign up through the expansion of Medicaid.

The federal numbers also are below expectations. Early on, the administration indicated it hoped to have 7 million Americans enrolled by the deadline. To hit that goal, another 3.7 million Americans would have to enroll in the next six weeks.

HHS Secretary Kathleen Sebelius announced the latest enrollment numbers Wednesday.

New Jerseyans are buying health insurance through the federal website, Healthcare.gov, which had a glitch-plagued rollout on Oct. 1, but has since improved.

Jill Roman, a spokeswoman for AmeriHealth New Jersey, said in contrast to October's troubled rollout of Healthcare.gov, "The overall process has improved considerably."

Roman said 80 percent of enrollments came in from Dec. 10 through Dec. 24, and AmeriHealth gave a few extra weeks for consumers to pay their first month's premium.

"We continue to see tremendous interest from consumers," she said. "Open enrollment continues through March 31, so it is still too early to assess overall success."

The ACA provides generous subsidies for low- and moderate-income Americans who buy health insurance on the marketplace. In New Jersey, three insurance companies are selling plans on Healthcare.gov: Horizon Blue Cross Blue Shield of New Jersey, AmeriHealth New Jersey and Health Republic Insurance of New Jersey, a new coop insurance company created with loans provided by the ACA.

John Sarno, president of the Employers Association of New Jersey, said enrollment has been slow for several reasons: the problems with the Healthcare.gov website and New Jersey's decision to use the federal marketplace instead of creating state-run marketplace.

But more than that, the HHS choice of 'navigators' — groups that provide enrollment advice to the uninsured — resulted in a lot of the uninsured being missed, Sarno said.

"The vast majority of uninsured New Jerseyans work full- or part-time service and labor jobs for a small employer. A good place to reach these workers would have been at their work site," he added.

According to HHS, in January, 27 percent of those who bought plans in the marketplace are between the ages of 18 and 34. HHS said young adult enrollment grew by 65 percent in January, from 489,460 at the end of December to 807,515 as of Feb. 1.

The Marketplace enrollment does not include the thousands of New Jerseyans who have enrolled in Medicaid through the expansion of the program under the ACA.

Joel Cantor, director of the Rutgers Center for State Health Policy, said "Medicaid applications are very much as I would expect at this stage."

He said the sale of insurance policies on the marketplace "remains below expectations, but the trend is positive. One possible reason for the lower-than-expected private plan enrollment may be that people were allowed to renew their old plans toward the end of 2013. Those people are not required to enroll in a new plan until their 2013 plan expires, which could be as late as December. These people will likely transfer to plans in the marketplace when their current plans expire."

Cantor pointed to the major unanswered question of the ACA: "We do not yet know whether the uninsured are enrolling in marketplace plans. That will be the true test of the success of the ACA."

Linda Schwimmer, vice president of the New Jersey Health Care Quality Institute, said New Jersey's current enrollment is about 25 percent of the total anticipated enrollment target for the next few years.

Still, she found the numbers encouraging so far, especially the enrollment figures for young adults.

"People have six more weeks to shop," Schwimmer said. "Most people are deadline-driven and procrastinate. That could drive higher volume as we get closer to the March 31 deadline."

As predicted by the Rutgers Center for State Health Policy, about 82 percent of those who bought coverage on Healthcare.gov received a subsidy, Schwimmer added.

"This makes sense because, in New Jersey, people were not shut out because of preexisting conditions; they were shut out by cost. They just couldn't afford the premiums. Now they can get a subsidy to help purchase insurance," she said.

Raymond Castro, senior policy analyst for the Trenton think tank New Jersey Policy Perspective, agrees that "the enrollment numbers look very promising." 

He said NJPP has been working with key health care stakeholders, including insurers, to establish monthly targets for enrollment.

"So far the state is meeting the targets and we expect that enrollment in Medicaid will exceed its target," he said. "This is very much a success story — at least so far. "

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