Obamacare Sign-Ups Reach 6.4 Million

WASHINGTON, DC - NOVEMBER 10:  U.S. Health and Human Services Secretary Sylvia Matthews Burwell talks about the upcoming heal
WASHINGTON, DC - NOVEMBER 10: U.S. Health and Human Services Secretary Sylvia Matthews Burwell talks about the upcoming health care exchange enrollment period at the Center for American Progress November 10, 2014 in Washington, DC. Burwell said the Obama Administration projects that 9.1 million people, including new applicants and returning customers, will be enrolled in 2015. (Photo by Chip Somodevilla/Getty Images)

Enrollments via the federally run Obamacare health insurance exchanges on surged leading up to a big deadline last week and reached almost 6.4 million after the first month of sign-ups, the Department of Health and Human Services announced Tuesday.

That tally, including about 1.9 million new customers and the re-enrollments of millions more already covered by Obamacare plans, combined with more than 1 million sign-ups so far through the exchanges operated by 13 states and the District of Columbia, appears to put the program on target to surpass Burwell’s self-imposed target of 9.1 million total enrollments by the end of next year. The open enrollment period for health insurance policies purchased on these exchanges for 2015 started Nov. 15 and ends Feb. 15, 2015.

“We still have a ways to go and a lot of work before Feb. 15, but we do have an encouraging start,” Health and Human Services Secretary Sylvia Mathews Burwell said at a press conference Tuesday. “This law is working, and families and businesses and taxpayers are better off as a result.”

Compared to the chaotic rollout of the Affordable Care Act’s exchanges in October 2013 that resulted in sluggish sign-ups for the first months of enrollment into 2014 health coverage, the second enrollment period is running remarkably smoothly at the federal and state level. That’s in spite of lingering technical issues and major public outreach and educational challenges facing exchange authorities and insurance companies seeking to usher existing customers through a potentially confusing renewal process while searching for millions of uninsured to sign up.

“A month ago, people were raising questions about whether or not consumers would actually come to the marketplace,” Burwell said. But the website is working, more insurance companies are offering policies compared to last year, and premium increases are modest on average, she said.

These private health insurance plan enrollments as of Dec. 19 are in addition to the almost 10 million people who have signed up for Medicaid or the Children’s Health Insurance Program since last October. The Affordable Care Act broadens Medicaid access in states that elect to participate, but 22 states have not done so, leaving millions of low-income Americans uninsured.

Just 106,000 people managed to sign up during the first month of the inaugural enrollment period, while more than half a million chose policies during the first week of this year’s campaign.

The improvements at the federal level are mirrored in the states with their own insurance marketplaces. States with troubled exchanges last time around, including Maryland and Massachusetts, have rebounded, and other states still having technical problems, such as Minnesota, nevertheless are signing up consumers. The exchanges in the populous states of California and New York performed well during the first enrollment period and continue to enroll large numbers of residents.

“It definitely looks like it’s going to work," Caroline Pearson, vice president of the health care reform practice at the consulting firm Avalere Health, said before the HHS announcement. "All signs are that the markets are working really effectively. You’ve got an increased insurer participation and very stable premiums,” she said. The average nationwide price increase for next year is 5.4 percent, but there's a lot of variation and some premiums even went down, according to PricewaterhouseCoopers.

In addition to the 1.9 million new customers who signed up, about 4.5 million current customers have re-enrolled for next year. Most of them automatically were rolled over into their current plans -- or the next closest thing if their policies have been discontinued -- for 2015.

Significantly, however, more than one-third of existing customers took active steps to re-enroll, rather than opting to be automatically re-enrolled, Burwell said. According to the department’s preliminary analysis, a share of current enrollees in the mid-to-high 30 percent range did so; this was more than expected based on how people with other types of coverage, including job-based health benefits, tend to keep the same plans every year rather than comparison shop, she said.

“In looking at what happens with people in employer-based plans and other things, I think probably wouldn’t have expected a number that high in terms of people’s behavior,” Burwell said. This could mean fewer of consumers than feared will suffer sticker shock next month.

Shopping around is crucial to consumers looking to avoid big rate hikes, especially for the more than 8 in 10 enrollees who receive Obamacare tax credits. Volatility in health insurance premiums, especially among those plans used to set the value of the Obamacare subsidies, means more than 70 percent of people who signed up for these plans could save money by changing to new policies, according to HHS.

Consumers who are automatically re-enrolled can switch to a cheaper policy for February if they make a change by Jan. 15, and all enrollees can choose a different plan for the rest of the year by Feb. 15. But anyone who didn’t choose a new plan by Dec. 15 will have to keep what they have in January, unless they opt to go uninsured for the month instead.

Avalere Health expects 4.5 million to 6 million new customers will sign up for health insurance via the exchanges by Feb. 15 and that total enrollments will reach 9.5 million to 11 million, including renewed coverage for current customers. The Congressional Budget Office projected enrollments would reach 13 million by the end of 2015.

Despite the positive trends for 2015 enrollment, projections from Avalere, the Congressional Budget Office and the Department of Health and Human Services are lower than before the beginning of the first-sign up period, and evaluations of the exchanges’ performance during the 2015 sign-up phase should consider that, Pearson said.

“It looks good relative to the expectations or the goals that HHS set for themselves, but it looks a bit disappointing relative to where we thought we would be a year ago,” Pearson said. “It has proven harder to do the outreach and get people to sign up than we expected and it’s been harder to keep people enrolled.”

Exchange enrollments for 2014 peaked at more than 8 million, but dipped to 6.7 million as of October as a share of customers gave up their plans, for reasons including not being able to afford the premiums, not valuing the coverage, gaining employment at companies that offer health benefits or enrolling into Medicaid because their incomes fell. HHS expects 83 percent of the total number of enrollees as of Feb. 15 to still be covered by exchange plans at the close of 2015.

Pearson expects enrollments to spike again by Jan. 15, as current customers who didn’t shop around scramble for lower-cost policies for the rest of the year, and then again when the final deadline arrives on Feb. 15.

This article has been updated with additional information from a news conference with Health and Human Services Secretary Sylvia Mathews Burwell and from a federal report.

To see an estimate of how much your health insurance might cost, use this calculator from the Henry J. Kaiser Family Foundation: