So how many have paid ACA premiums?
By: Kyle Cheney
March 13, 2014 12:07 AM EDT
The White House insists it doesn’t know how many people are fully enrolled in Obamacare, but insurers say they’ve handed over enough data to show that the sign-up numbers are not as rosy as federal officials say.
The latest administration figures show that 4.2 million people have selected health plans in the new insurance markets. Insurance industry officials at four of the big national health plans tell POLITICO that about 15 to 20 percent of people who have signed up have not yet paid their first monthly premium — the final step to get coverage.
And they’ve told the White House that, too, insurance industry officials say.
“They have a lot more information than they’re letting on,” one industry source said of the Obama administration. “They have real hard data about the percent that have paid … If they have not processed those yet and compiled the data, that is a choice they are making. But they have that data now.”
Federal officials say they count sign-ups — people who select plans on HealthCare.gov or in state exchanges — because they can’t yet rely on the insurers’ figures. They say the industry reports are not comprehensive, and they change month to month.
“I can’t tell you because I don’t know that,” Health and Human Services Secretary Kathleen Sebelius said Wednesday when Republicans asked about the number of paying Obamacare customers during a hearing on Capitol Hill. “We don’t collect it.”
The dispute emerges as the administration is trying to convey a sense of enthusiasm and momentum ahead of a March 31 deadline to enroll in Affordable Care Act exchanges. But unless the current pace doubles, the administration won’t hit its target of 6 million people — a goal that was already scaled back from 7 million after last October’s messy rollout of HealthCare.gov.
But the hill to climb may be even steeper than the White House acknowledges. Once the premium payment rate is factored in, the actual count of people who now have health coverage under the president’s health law could be closer to 3 million than 4 million. The insurance exchanges may still work with fewer people — but the political narrative is that the controversial health law is again falling short.
The White House insists that industry claims notwithstanding, it can’t provide precise enrollment totals — and may not be able to for months because major “back end” components of HealthCare.gov are still under construction. Those pieces are supposed to collect data directly from insurers about the number of premium-paying customers on their rolls.
Last month, White House spokesman Josh Earnest said reporters would have better immediate luck getting accurate coverage numbers from insurers.
“Questions about who exactly has paid for the health insurance can best be directed to those private insurance companies that are collecting those payments,” Earnest said.
Of course, there are hundreds of insurers, and not all of them have readily released their number of paying Obamacare customers. Several major ones have, however.
Aetna and Health Care Services Corp., two of the country’s largest insurers, told POLITICO that through February, about 80 percent of their exchange customers had paid. Officials from WellPoint and Blue Shield of California said about 85 percent of subscribers had submitted premiums. A handful of other large- and medium-sized insurers told The New York Times last month that about four of five of their January customers had paid.
If those trends are correct nationally, the White House in fact fell short of its initial January enrollment target of about 1 million customers despite a round of positive press about the administration meeting its goal — headlines President Barack Obama touted during a conference last month with House Democrats.
A White House official said the administration can’t provide the more precise enrollment total because the data it receives from insurers are incomplete — they come only from plans that are covering people who are getting federal subsidies to buy insurance. Those paying full price for their coverage are not included, the official said.
“Eventually, they will have info on who paid overall, but right now, the insurance plans themselves are the only ones that have comprehensive info,” the official added, noting that some insurers have opted against sending complete enrollment data until HealthCare.gov is fully built.
An official with the Centers for Medicare & Medicaid Services made the same point, saying the agency is getting only “aggregate-level” numbers from a subset of insurers. “This aggregate-level estimated enrollment data is not a complete or reliable picture of total individual enrollment or payment,” the official said.
Insurance industry sources reject that assessment, noting that insurers are actually providing several streams of data — not just from subsidized plans — that give an accurate snapshot.
For example, companies are required to pay a 3.5 percent monthly fee to the government based on the premiums paid by their enrollees, a calculation that covers all paying customers. They’re also manually providing enrollment notes to CMS while those additional HealthCare.gov systems are being built. Finally, insurers must send a confirmation form to Obamacare exchanges whenever they receive an enrollee’s first payment.
At the least, said Robert Laszewski, an insurance industry consultant, the government “should have hard numbers for January.” And given that some companies have readily volunteered their paid enrollment figures to reporters and others, Laszewski added, the administration could simply ask for the same.
Administration officials have argued that even some of the more detailed information they get from insurers has to be fact-checked and verified before it’s ready for release — a process they describe as “scrubbing the numbers” to ensure they’re reliable. Some plans, they note, have made big adjustments in their enrollment totals from month to month — known in the industry as “restatements” — as they comb through their own records.
The administration’s own monthly enrollment reports contain numerous caveats about shortcomings in the details being released.
Kip Piper, a former CMS adviser during the administration of President George W. Bush, said the administration’s reluctance to calculate more accurate enrollment numbers is an obvious and wise messaging tactic.
“They don’t want [to] provide new cannon fodder for use by ACA opponents,” he said in an email. “Right now, the administration is benefiting from the opaqueness of ACA’s impact on the ground. It leaves it in the realm of anecdote, and it’s easy to combat anecdotes with counteranecdotes and the broad, imprecise monthly reports. It may be seen as shameless, but it’s a political no-brainer.”