HHS is boasting of enrollment for November that was four times as high as October, yet 62% of the total was in the state exchanges, some of which are marginally less prone to crashing than the federal version. Then again, 41 states posted sign-ups only in the three or four figures, including eight states that run their own exchanges. Oregon managed to scrape up 44 people. Among the 137,204 federal sign-ups, no state is reaching the critical mass necessary for stable insurance prices.
The larger problem is that none of these represent true enrollments. HHS is reporting how many people “selected” a plan on the exchange, not how many people have actually enrolled in a plan with an insurance company by paying the first month’s premium, which is how the private insurance industry defines enrollment. HHS has made up its own standard.
Insurers know that the hardest part of doing business in the individual market is getting customers to write a check. People are accustomed these days to automatic payroll deductions and the unseen lost wages of employer-sponsored insurance. Many Americans may enroll on the exchange but then fail to pay once they see monthly costs that could range from the equivalent of a cellphone bill if they qualify for subsidies (President Obama’s favorite comparison) to premiums that can exceed $1,000 or huge deductibles for the unlucky who must overpay to finance the insurance of others.