Exceeding Expectations: How the PPACA Exchanges Broke 7M

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In the weeks leading up Monday's open enrollment deadline for the health insurance exchanges, analysts predicted that the Patient Protection and Affordable Care Act marketplaces would fall short of signing up 6 million people, the latest Congressional Budget Office benchmark.

As of March 1, HHS reported more than 4.2 million people had selected health plans through the PPACA marketplace. Earlier this month, healthcare business advisory company Avalere Health projected the exchanges would reach 5.4 million by March 31.

However, a significant surge of sign-ups in the days before the deadline lead Avalere to revise its estimate, saying the exchanges could meet or even exceed 6 million. Yesterday, President Barack Obama announced the exchanges had blown past that goal, reaching 7.1 million enrollees.

"No one expected us to come back from the brink or to surpass the revised CBO projection that 6 million consumers would sign up in year one, but we have," White House Press Secretary Jay Carney said at a press briefing Monday. The exchanges saw a surge of interested consumers right before the deadline, with "people lining up around the block" and 2.9 million visits to HealthCare.gov this past weekend, he said.

Matt Eyles, executive vice president of Avalere, says the PPACA exchange enrollment near the end of March was dramatically different from what they experienced at the beginning of the month. "In the beginning of the month they were probably enrolling 40,000 to 50,000 per day," he says. "The last few days, they were well over 100,000 per day, maybe as high as 200,000 on the peak days at the end."

He attributes the sign-up surge to marketing efforts by federal officials and advocacy groups, including President Obama's plug for HealthCare.gov on the popular FunnyorDie.com webseries "Between Two Ferns." The nonprofit Enroll America also ramped up its Get Covered America campaign during the last two weeks of open enrollment, hosting events in communities across 11 states.

Although the enrollment numbers vary from state to state, Mr. Eyles says the higher-than-expected enrollment figure shows "there is a viable exchange market in every state in the country."

"It appears that exchange enrollment occurred everywhere, even in problem states like Maryland and Oregon," he says. "I think it's pretty clear that exchanges are likely here to stay and will continue to grow their enrollment over time."

However, it's still unclear how many of the last surge of enrollees fell into the "young invincible" category — those between the ages of 18 and 34. Without an adequate amount of "young invincible" enrollees, the total amount of premiums health insurers collect for exchange plans will be less than the total healthcare expenses of exchange enrollees, and insurance companies could increase premiums to compensate. However, a report from the Kaiser Family Foundation found a premium "death spiral" is unlikely to occur and insurers can still expect to earn profits even if only 25 percent of exchange enrollees —the "young invincible" percentage as of March 1, according to HHS — are young adults.

"We're eagerly awaiting the final details around that and whether or not this sharp increase at the end was the result of younger people," Mr. Eyles says.

He also says the 7.1 million figure may move around a bit. People who have signed up for health plans won't technically have coverage until they pay their first premiums, and those who signed up at the very end of the open enrollment period won't see their health insurance take effect until May. "It's going to be an evolution to figure out how the program is working and what kind of changes we might see in the future," Mr. Eyles says.

More Articles on PPACA Enrollment:
Obama Announces April 15 Cutoff for PPACA Enrollment Extension
Obama Administration: PPACA Enrollment Tops 7M
Maryland to Rebuild Health Insurance Exchange Website 

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