By all accounts, the enrollment numbers for the Affordable Care Act are improving. As of Wednesday, 3.3 million people had selected plans on either a state or the federal insurance market places, according to the Department of Health and Human Services.
But the administration’s figures rely heavily on the word “selected.”
The 3.3 million number includes individuals who both have and have not yet paid their first month’s premium. This is a diversion from the insurance industry standard of only considering someone enrolled after paying the first month’s bill.
Despite there only being six weeks left in the open enrollment period, the administration has yet to reveal who has paid their first premium.
“As soon as we have our automated payment systems complete and tested, we believe we’ll be able to provide you additional data in terms of those consumers who have paid their premiums,” HHS spokeswoman Julie Bataille told reporters on Wednesday.
Insurance companies need these payments in order to support their risk pools, which although improved, still tend to be more heavily weighted by older enrollees. As of Wednesday, 25% of the people enrolled in plans were between the much-needed demographic of 18-to-34.
Under the Affordable Care Act, every individual in the country has to have insurance by the end of open enrollment period on April 1 or face a fine of $95 a year, or 1% of their annual income, for failing to comply.
Back-end tech problems continue
The full implementation of a back-end mechanism that allows the government to pay insurers for enrollees who receive subsidies or are enrolled in cost-sharing plans is part of the reason HHS can’t provide accurate payment numbers, according to Paul Howard, director of the center for Medical Progress at the Manhattan Institute.
“They have been taking these bills from insurers on an honor system and reconciling those month to month,” Howard says. “So they may not know the total picture. But they certainly could make data available based on what they have now.”
But as more people continue to sign up on the exchanges, the back-end technological issues will only be exacerbated, worries Larry Kocot, visiting scholar at the Brookings Institution. Aside from the payment mechanism, some insurers are receiving incorrect data on 834 forms, which are key because they provide enrollment information to the companies.
“If those issues are not resolved, and the government still hasn’t figured out how to pay, this will only be made worse by higher enrollment numbers, and become more pronounced,” he says.
HHS is also not requiring insurance companies to notify them daily of new enrollees, figures are submitted on a rolling basis and numbers are reconciled at the end of each month.
“It’s reasonable to not ask insurers to [update enrollment numbers] in real time,” Howard says. “But HHS does have some data because they are paying insurers.”
The trouble with releasing data as it comes in, is that it’s only a snapshot in time, Kocot says. “This is a moving target, for many reasons. The insurers certainly know how many people have paid, and could gather the data, but it will be consistently incomplete.”
As the enrollment period continues, Kocot is focusing on the payment numbers, how many enrollees previously had insurance and how many people will continue to pay their premium. Enrollees can technically pay their first month’s premium and then skip for up to 90 consecutive days before insurance companies can kick them off the plan.
Payment estimates and competition amongst insurers
Bob Laszewski, who writes the Health Care Policy and Marketplace Blog, wrote on Feb. 7 that industry sources tell him that 80% of new enrollees have paid their monthly premiums.
Insurers may be reluctant to give stats because they are technically in competition with one another, Kocot points out. Insurers were hesitant to divulge enrollment stats early in the season for the same reasons.
“You can view it as a competitive issue—no one wants to say they aren’t getting payments,” he says.
Howard adds the they also don’t want bad press.
“Insurance companies want to give people all the reasonable time they need to make a payment—they don’t want the bad press associated with people not paying,” he says.