Jesica Arias, meets with clients at AltaMed Resource Center to guide them through applying for insurance under the Affordable Care Act in Commerce, Calif., Jan. 30, 2014.
Monica Almeida/The New York Times/Redux

Obamacare signups climb slowly as deadline looms

With just three weeks remaining in this year’s health care enrollment season, the Obama administration is touting another surge in signups—nearly a million last month—and racing to recruit 2 million more by March 31.

In an issue brief released Tuesday afternoon, federal health officials reported that 4.2 million people have found private health coverage through the new insurance exchanges since they opened for business last October. The total number of enrollees jumped by 29% during February, as 943,000 people signed up through state- and federally-facilitated exchanges. The February figure fell short of January’s 1.1 million, mainly because February was shorter and the January total included some late-December enrollments.

In a Tuesday-afternoon conference call, reporters pressed the administration on whether it still expects to reach the 6 million mark by March 31, as the Congressional  Budget Office has predicted. Officials would say only that enrollment is on “the right trajectory,” but 6 million is still conceivable.

As the report notes, “Action-forcing events—such as the end date of an open enrollment period or the start date for benefits—often result in a spike in enrollment activity.” The number of enrollees more than doubled during December (from 364,700 to just over 1 million), as the deadline approached for coverage that would kick in at the beginning of 2014.

Besides being the last day to buy coverage for 2014, March 31 is the last day uninsured people can avoid 2014 tax penalties for going without health coverage. This year’s penalty is $95 or 1% of one’s income (whichever is larger), but the threat could help motivate young adults, who are more likely than older folks to act at the last minute.   

Who, exactly, is buying all these insurance plans?

As a group, the first 4.2 million enrollees are older than health experts had hoped. Ideally, 40% would be 18 to 34 years old—a group whose good health helps to keep rates down for everyone. So far, only 25% of the newcomers belong to that group, but the proportion is rising from month to month. The new report notes that young adults make up 27% of January-February enrollees, versus 24% of those who signed up during October, November and December.

Nearly two-thirds of the new entrants have chosen silver-level plans—pricier than bronze, but cheaper than gold or platinum—and 83% of subscribers will get some level of financial assistance. The Affordable Care Act uses tax credits to cut the cost of coverage for people earning one to four times the federal poverty wage. The law also lets states expand Medicaid at federal expense. In addition to the 4.2 million people now securing private health plans, more than 6 million have gained Medicaid coverage in the 26 states that are expanding their programs. 

“More and more Americans are gaining the peace of mind and financial security that comes with having health insurance,” the advocacy group Enroll America said in a statement on the new figures. “We’re confident that enrollment will continue to accelerate as we approach the March 31st deadline for coverage.”

Unfortunately, it’s still not clear how many of those buying coverage through the exchanges were previously uninsured. The new mandates and marketplaces are intended specifically to extend coverage to people who lack it, but the administration’s new report avoids any mention of that issue—even though the government records people’s current insurance status when they apply for financial assistance. When pressed on the issue during Tuesday’s conference call, officials refused to discuss it on the grounds that a tiny fraction of applicants hadn’t sought financial assistance and their prior insurance status wasn’t known.

That question won’t go away, but expanding insurance coverage is a long-term project. The president’s immediate challenge is to boost total enrollment over the next three weeks. His comedy appearance on Between  Two  Ferns reportedly drove 1,900 online viewers to on Tuesday, and Obamacare supporters will be out in force for the rest of the month, rallying people to act in their own interest. In practical terms, hitting 6 million is of no particular consequence. Politically, it would be a godsend.