The Affordable Care Act celebrated its 21st week of open enrollment with improving enrollment numbers and another delay.

The Department of Health and Human Services reported Wednesday 3.3 million Americans have now selected plans on either a state or the federal exchange with 1 million enrolled since January. Younger people are also showing stronger enrollment stats, with 25% of the total pool being between the ages of 18 to 34.

While the Obama Administration has been touting the improving figures, they are still far from the original projections it set earlier for the law’s first year of 7 million enrollees with 2.7 million of them being ages of 18 to 34. This young demographic is critical to the law’s success as they will offset the premium costs for older and less healthy enrollees.

Susan Dentzer, senior policy advisor at the Robert Wood Johnson Foundation, points out the Congressional Budget Office revise its own predictions for year one enrollment to 6 million people last week—but  the clock is ticking as there is only a little more than six more weeks until enrollment season ends.

“We are a little more than halfway there, and clearly enrollment is picking up as everyone expected it to be,” Dentzer says. “Youth enrollment is also variable around the states; the head of D.C.’s exchange is reporting that 40% of its enrollees are young.”

Paul Howard, director of the Center for Medical Progress at the Manhattan Institute, says the numbers show slight improvement, but he still has more questions.

“It’s not much to crow about,” Howard says. “We don’t really know how many of these people had prior coverage, and the health status of this population.”

Who Has Paid Their Premiums?

The White House provided more clarity on enrollment figures, but it’s still unclear how many of these people have actually paid their first month’s premium.

The insurance industry typically considers people enrolled once they have made that first payment. Reports surfaced late this week that 20% of those who have signed up for a plan on the exchanges have yet to pay.

Howard worries that 20% is made up primarily of younger enrollees on the fence about actually paying for coverage.

“This means 20% of people are basically shadow signups,” Howard says. “They may decide at the end of the day that they won’t pay their premiums, or they may be young and healthy people that decide to not buy, which may hurt the risk pool. This could make the situation worse for insurers and the government.”

The ACA mandates that every individual in the country have insurance by April 1, or they will face a fine of $95 a year or 1% of their annual income for failing to comply.

The Small Biz Delay

The Obama Administration also announced its 12th delay or tweak to the law since open enrollment period kicked off on Oct. 1. This time it pushes back an employer responsibility provision to 2016.

Businesses with between 50 and 99 employees won’t have to comply with the employer mandate portion of the law until 2016. The mandate requires every business owner with at least 50 or more full-timers to offer them coverage or face a penalty of $2,000 per worker, per year. This mandate was originally planned to go into effect this year.

Treasury insiders say the move was due to increased pressure and complaints from business owners.

“I think it’s politically-driven and could force insurers to resurrect plans they may have planned to discontinue,” he says. “It hurts insurers trying to figure out their risk pools. And, it sends a broader implementation that that the employer mandate may go away.” He says the delay could is a sign that the employer mandate may be completed repealed.

Dentzer says repeal is in the realm of possibility, as is hitting the year one CBO enrollment projections.

“It’s in the realm of the possible, sure, but is it probable?” Dentzer says of doing away with this portion of the law. “I don’t think so. Clearly what the administration is doing, leaving aside political consideration, is admitting this is a big transition on many levels. I think that frankly, the lesson of the exchanges was that sometimes it’s better to take more time to get things right.”

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