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Wednesday, November 13, 2013

Obamacare in Arkansas: "private option" going swimmingly, rest of Health Insurance Marketplace hasn't gotten going

Posted By on Wed, Nov 13, 2013 at 5:28 PM

For the first time, the Obama administration released numbers today on enrollment in plans on the new marketplaces created by the healthcare law. The federally run signup portal,, has been operating poorly (to say the least) and as expected, the numbers are underwhelming. In total a little more than 106,000 Americans have enrolled in plans, well short of the initial projection from the administration that 500,000 would have enrolled by now (7 million were initially projected to sign up through the end of the open enrollment, which lasts through the end of March). In Arkansas, only 250 people have completed enrollment.

Enrollment was always expected to be light early and pick up as deadlines for signing up approach, and the raw enrollment numbers don't necessarily tell us much about how well the Obamacare marketplaces will function. The big issue, of course, is the website — thousands of people interested in signing up have been unable to. It's hard to get any sort of snapshot of how enrollment is going until (unless!) the website is fixed. Of the approximately 106,000 Americans who have enrolled, 79,000 came from the 15 states and the District of Columbia running their own marketplaces, where websites have generally functioned much better, while just 27,000 came from the 36 states using the federal portal. A further look at the numbers suggests hints that we'll see an increased pace going forward; for example, around a million Americans have filled out an application and been deemed eligible but haven't yet picked a plan (more than 6,000 in Arkansas, plus another 7,430 who applied and were sent to the "private option"). 

All of that said, there's no doubt about it: 250 Arkansans is a very low number. It will need to increase dramatically over the next several months in order for the Health Insurance Marketplace to function in Arkansas. Obamacare critics will gleefully chortle as long as enrollment lags, but worth remembering that, politics aside, a failure to attract a relatively healthy pool of people to the Arkansas marketplace will lead to higher premiums for thousands of Arkansans dependent on the marketplace for insurance. That's what's at stake. 

It's important to make a distinction because I keep hearing people conflating them: There are two Obamacare enrollment stories in Arkansas right now. While the faulty federal website has derailed the early rollout of the Health Insurance Marketplace, the rollout of the "private option" — which uses Medicaid funds via the Affordable Care Act to purchase private health insurance for low-income Arkansans — has been an enormous success. The Department of Human Services released the latest numbers yesterday: 73,807 applications, of whom 64,445 have been deemed eligible, with the rest still pending. Of those, 49,787 have either picked a plan or been auto-assigned a plan; 4,639 with exceptional medical needs have been routed to the traditional Medicaid program. See here and here for more context on "private option" enrollment, auto-assignment, etc. 

DHS has a website for applying to the "private option" and another one for picking a plan if deemed eligible, and both are working just fine (note: these are separate websites both from and from the AR Health Connector site run by the Arkansas Insurance Department). While "private option" enrollees are choosing among the same plans as other consumers on the Marketplace, the enrollment process is completely different. Medicaid expansion (the "private option") and reforms to the individual market (the Health Insurance Marketplace) are two distinct parts of Obamacare.

It all gets a little confusing, I know! But don't let this fool you: sometimes you'll hear people discussing whether Arkansas should continue with the "private option" policy bring up the woes of or the early enrollment numbers for the Marketplace. While both are authorized by the same federal law, one really has nothing to do with the other. 

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