WASHINGTON — More than 1.1 million people signed up for health insurance through federal and state marketplaces in January, according to the government, and the number of young people enrolling increased faster than that of any other group.
The results were hailed by Obama administration officials, who expressed increased optimism that they had overcome their initial stumbles and erased many doubts about the viability of the health care law.
Most promising, according to the Department of Health and Human Services, is that 25 percent of those signing up for insurance from October through January were ages 18 to 34 — the young and presumably healthy people whom insurance companies need as customers in order to keep premiums reasonable for everyone.
“These encouraging trends show that more Americans are enrolling every day, and finding quality, affordable coverage in the marketplace,” said Kathleen Sebelius, the secretary of health and human services.
The steady march of sign-ups for insurance coverage is doing little to tamp down a political fight over the Affordable Care Act that is expected to come to a head this fall as lawmakers in the House and Senate seek re-election.
GRAPHIC
Health Exchange Enrollment at 75 Percent of Target
More than 1.1 million people signed up for private insurance in federal and state exchanges in January, bringing the total to 3.3 million in the first four months of enrollment.
Republican critics of the law said the overall numbers — 3.3 million people have signed up since the troubled HealthCare
.gov website went live on Oct. 1, below the administration’s goal of having 4.4 million people enrolled by now — were evidence of the law’s certain failure.
.gov website went live on Oct. 1, below the administration’s goal of having 4.4 million people enrolled by now — were evidence of the law’s certain failure.
But industry experts and insurance officials say that the reality is murkier than either party wants to admit, and that the numbers at the heart of the national political debate are largely meaningless outside Washington’s overheated environment. The determination about whether the law works from an economic standpoint will not be clear for years, when individual insurance companies are finally able to tell whether their expectations about the health of their customers — and the premiums they set for coverage — were accurate.
Provisions in the health care law are designed to buffer any economic shocks for insurance companies until 2016 and beyond. And the economic fate of the biggest health care overhaul in decades will be decided state by state, in hundreds of individual markets across the country, not in a theoretical national insurance marketplace that does not really exist.
“There’s going to be tremendous variation in the country,” said Drew Altman, the president and chief executive of the Kaiser Family Foundation. He said the focus on national numbers, like reaching the target of enrolling seven million people in the first year, “never had anything to do with the real success or failure of the law.”
Brian Lobley, an executive with Independence Blue Cross, a Philadelphia insurance company, said it would take time to see how the market evolved. “From our standpoint, we have always looked at this as a multiyear journey,” he said.
Officials said Wednesday that the fastest growth in enrollment during January occurred among young adults. And they said that most young people were choosing “silver,” “gold” or “platinum” coverage plans, not the low-cost, bare-bones “bronze” options that are also available.
“The covered population is getting younger,” Ms. Sebelius said. In January, 318,000 people ages 18 to 34 selected health plans, bringing the total in this age group to 807,500, officials said.
To make a market work, insurers must enroll a mix of young, healthy people and sicker, older customers who will have expensive medical conditions. If too few people sign up, and they have high medical bills, insurers will have to raise premiums high enough to cover those expenses. As premiums rise, the market becomes less appealing to healthier individuals, setting off a vicious circle of higher rates that price more people out of the market.
Insurers say they are more focused on whether they priced their plans to account for the health of people enrolling. WellPoint, which has said it has signed up about 500,000 people, recently told investors that it was comfortable with its pricing. Independence Blue Cross has enrolled 67,478 people, including 40,000 who signed up through the exchanges. Mr. Lobley said that he was pleased with those numbers, but that the pricing for premiums in 2016 would be critical.
“Really the challenge for us, and for everybody else, is to get the pricing right,” he said. “That’s the biggest wild card out there.”
White House officials concede that the law’s success will be determined on a state-by-state basis. But they say that most markets across the country have attracted plenty of competition from insurance companies. And those companies are offering a variety of plans with premiums that are competitive, they said.
“There’s not going to be an ‘Aha!’ moment,” one White House official said. “But there are mile markers.”
The dueling political messages foreshadow more black-and-white, election-year talk, in which both parties are preparing to spend millions of dollars to define the health care law as either a miserable failure or an important success.
“The case for repeal is infinitely harder now that people actually have coverage,” said Dan Pfeiffer, a senior adviser to the president, who added that the increased momentum of enrollment documented in Wednesday’s report gives the advantage to Democrats. “A message of ‘elect me so I can take health care away from my soon-to-be constituents’ is a dead-bang loser.”
Republicans, however, see the issue as a winning one in the coming midterm elections.
“With embarrassing failures, broken promises, shifting deadlines, and miserable enrollment numbers, the last few months have been a rolling catastrophe,” said Brendan Buck, a spokesman for Speaker John A. Boehner. “This is what happens when you offer one-size-fits-all plans that come with high costs for limited access to your doctor.”
Officials also point out that there are provisions in the Affordable Care Act that help guard against premium increases during the next few years. The programs, which include “risk adjustment” and “risk corridors” provisions, should help insurance companies keep rates low even if their initial mix of customers in a given plan is not ideal, officials said, because they protect an individual company if it enrolls people who are much sicker than expected. Some Republicans have attacked the protections as bailouts for insurance companies, and said they should be repealed.
But others are not so sanguine.
Steve Zaharuk, a senior vice president at Moody’s Investors Service, warned that young, healthy people might stay away because they do not see the value in coverage and the penalties are too low to discourage them from remaining uninsured. He also worries that some will cancel their coverage.
What really matters, say policy experts and insurance executives, is the volume and makeup of people signing up in every market. The test will be whether insurers will stay in a market or have to raise rates by double digits in the coming years, creating potential turmoil. But policy and industry experts say insurers will not know for months or even years whether the individuals they are covering are more expensive to care for than they had expected.
via:http://www.nytimes.com/2014/02/13/us/over-1-million-added-to-rolls-of-health-plan.html?partner=rss&emc=rss
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