WASHINGTON – More than 4.2 million people have signed up for coverage on the nation's health insurance marketplaces through February, but low participation from young adults and early technical problems with the website have jeopardized the government's goal of enrolling 6 million people by March 31.
In the five-month period from October through February, 2.6 million Americans bought coverage through the federal HealthCare.gov website, while 1.6 million signed up through state-run insurance exchanges.
Experts had predicted that enrollments would increase as the six-month enrollment period neared its conclusion. But total monthly signups fell from more than 1.1 million in January to 942,000 in February.
And the proportion of young adults ages 18 to 34 who bought coverage remained at 27 percent in January and February, far from the 35 percent to 40 percent level that experts suggest is needed to keep premium costs in check next year.
This group of younger, typically healthy plan members is cheaper to insure and would offset the coverage costs for older plan members who are generally sicker and more costly to cover.
About 4.7 million people would have to have been enrolled in coverage in February in order to reach 6 million new enrollees by March 31, according to a new analysis by Avalere Health, a Washington consulting firm.
With just 4.2 million signups, that 500,000-customer shortfall will be tough to overcome in just one month – even with a national enrollment drive that's currently underway.
"Right now, I think it's a stretch to reach 6 million, but it's not impossible," said Caroline Pearson, Avalere vice president. "The real challenge is that so many of the folks who enrolled in 2013 had previous coverage or high health care needs, so they were motivated to enroll. They were engaged with the health care system. Reaching young uninsured people is a lot harder. And I think that's what we're seeing. So it's going to take some time."
In a telephone press briefing, officials at the Department of Health and Human Services wouldn't discuss their chances of hitting the 6 million mark, saying only that they expected "millions" more people to enroll by the end of March.
Nancy Delew, an HHS acting deputy assistant secretary, said last month's enrollment slowdown was because of the shorter reporting period of just 28 days in February compared with 31 in January.
Health and Human Services Secretary Kathleen Sebelius was encouraged that young adults accounted for one-third of February enrollments. And even though more than a million young adults have enrolled so far, she said past enrollment patterns show "that young adults tend to sign up later in the process."
"We expect that as Americans continue to learn just how affordable coverage can be, they'll use the next three weeks to get signed up and get covered," Sebelius said.
Unlike other Affordable Care Act timetables and deadlines that the Obama administration has extended, HHS doesn't have the statutory authority to extend the March 31 enrollment deadline, officials said.
Government officials were still unable to say how many people signing up for coverage were previously uninsured. Nor do they have reliable numbers on how many new enrollees actually have made payments on their new coverage. But a recent survey by the consulting firm McKinsey & Co. found that 75 percent of new enrollees had made their first payment, while the uninsured made up 27 percent of new enrollees.
Avalere's Pearson said that reaching 6 million enrollees is an "arbitrary" figure that won't really impact the cost of coverage. More important is the health status of those who enroll. Most plans set their 2014 rates assuming their enrollees would be older and sicker, Pearson said.
That's why increasing the share of healthy young enrollees is important to ensure that rates remain affordable in 2015.
"That's the million-dollar question," Pearson said. "Do premiums go up next year based on health status? Until we get a better sense of how these people actually use health services, it's hard to know."
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