HIX Enrollment Data Shows Wide Variances Among States

Health plan enrollment nationwide beat HHS's expectations, but fell short on attaining two key goals of federal officials: enrolling Latinos and adults between 18 to 34 years of age. The differences from state-to-state were, in some cases, pronounced.

The early results are in. While federal officials appear to have beat expectations for 2014 HIX enrollment nationwide, the performance of the new public exchanges varies state-to-state.

In a 45-page report released Thursday, the U.S. Department of Health and Human Services provided detailed demographic data on the people who signed up for individual health insurance policies on the new public exchanges between October 1, 2013 and March 31, 2014.

Some key findings:

• More than 8 million people signed up for health insurance policies through the Patient Protection and Affordable Care Act exchanges during the enrollment period
• About 28 percent of 2014 exchange enrollees (2.2 million people) are between 18 and 34 years old
• Nearly half of the people who signed up for exchange policies —3.8 million—signed up during "the March surge" at the end of the HIX open enrollment period
• About half of those who enrolled during the surge at the finish were in the 18 –34 age group, a coveted cohort for payers

The report reveals wide variances among states, but indicates that enrollment nationwide exceeded HHS's expectations. Last June, HHS Secretary Kathleen Sebelius and the federal Office of Management and Budget set the national enrollment target for the exchanges at 7 million beneficiaries.

Latino, Youth Enrollment Disappoint

The national enrollment data shows the exchanges fell short on two key goals of federal officials, the enrollment of Latinos and of adults 18 to 34 years old.

According to 2012 US Census Bureau statistics, Americans of Hispanic origin constitute the largest share of the country's uninsured population. At 15.5 million lives, nearly 1-in-3 uninsured Americans are Latino, the Census found.

The HHS report lists ethnicity statistics from the nearly three dozen exchanges that are administered by federal officials directly or in conjunction with the states. Of the 3.7 million beneficiaries who reported their ethnicity, only 403,632 were of Hispanic origin, slightly over 10 percent.

Richard Olague, a spokesman at the federal Centers for Medicare & Medicaid Services, said in an email Friday that exchange officials across the country face a challenge reaching Latinos.

"We always anticipated reaching the Latino community would require a unique approach that included more than having a Spanish website and offering bilingual support at the call center," he said. "Because of this, we took steps to utilize what we know are trusted messengers in the Latino community, including Spanish language media and community partners to provide as much in-person assistance to help educate and enroll the Latino community.

"Our goal remains to continue to educate… all Americans about the benefits and protections now available to them because of the Affordable Care Act," he said.

Young Invincibles
While it could have been much worse without "the March surge," the enrollment of people 18 to 34 years old still fell short of federal officials' hopes.

About 28 percent of exchange beneficiaries are in this age group, which represents about 40 percent of the population of Americans eligible to obtain insurance on the exchanges, says Elizabeth Carpenter, director in the healthcare reform practice at DC-based Avalere Health."

Speaking by phone Friday, she said, "we're certainly in the realm where the enrollee demographics will affect rates next year." The 2015 rates are highly likely to vary by health plan, she said, depending "on what their strategy was going in and what their strategy is going forward."

'State-by-state Question'
As exchange stakeholders pore over the 2014 beneficiary pool data in the coming weeks, they will be closely examining the state numbers. "This is not a national question," Carpenter said of analyzing beneficiary pools in the exchanges. "It is really a state-by-state, region-by-region question."

Multiple factors must be weighed when evaluating the beneficiary pools and associated risks for payers, she says, including the size of the state and the proportion of the state's population that was previously uninsured.

A handful of outlier states lie on both sides of the performance spectrum. The data released last week shows the District of Columbia and Hawaii "lagging behind" in overall enrollment, Carpenter said. Despite the Oregon exchange's decision last week to scrap its troubled state-administered website and to adopt the federal government's HIX website, HealthCare.gov, the West Coast beneficiary pools stand out positively, she noted. "California has exceeded expectations," and the Washington exchange also performed well.

"While Hawaii has had a hard time with its exchange, Oregon managed to come close to its enrollment target," Carpenter said. "There was a lot more that went into enrollment than just the performance of the exchange website."
Cover Orgeon's site performance was so bad that the FBI and the GAO have launched inquiries into what went wrong.

In Colorado, officials at the state-administered exchange are hopeful about their beneficiary pool. "There are many good signs," Linda Kanamine, director of communications at Connect for Health Colorado, said Thursday. "We are pleased to see an even distribution of enrollments statewide and that our young adult enrollments are increasing. Our focus continues to be on reaching more Coloradans and increasing access, affordability and choice."

Kanamine highlighted these data points:

• Enrollments by each county very closely mirror each county's percentage of total state population.
• 60% of those who signed up applied for and got tax credits – averaging $277 per month statewide. 
• "26% of our customers were between 18 and 34. Factoring in Medicaid expansion, almost 44% of those new enrollees are also in the 18–34 range.

A Payer's Perspective
Indianapolis-based Wellpoint Inc. is upbeat about its new exchange customers.

"We continue to process applications and payments from our new members, as this first open enrollment period under the Affordable Care Act has drawn to a close," Wellpoint spokesman Jerry Slowey said in an email Friday.

"Our new enrollees appear to generally match the federal government's projections for the industry… At WellPoint/Brand, we are proud to have been essential players from the start, encouraging enrollment across our fourteen states. As we move forward, we can all take pride that for the first time, millions of uninsured Americans have access to comprehensive health insurance."