Feb. 13—Enrollments in private health insurance plans offered through government-run marketplaces accelerated in January to bring total signups to nearly 3.3 million, federal officials announced this week.

The enrollments, which include an undisclosed number of people who have yet to begin paying their premiums to activate their coverage, came despite ongoing technical failures in federal and many state-run online health insurance enrollment websites. The heavily subsidized enrollments in public marketplaces, or exchanges, are a central feature of the Affordable Care Act (ACA) and required for most members of the public to avoid tax penalties that begin this year.

January enrollments totaled 1.1 million, which was ahead of monthly enrollment targets established by the Centers for Medicare & Medicaid Services (CMS). However, enrollments to date continue to badly lag projections that call for a total of 7 million to gain coverage during the ACA’s six-month open enrollment. Federal officials also did not reveal how many of the 3.3 million had recently lost their previous coverage due to other ACA requirements on insurance plans. According to the latest estimates, up to 4 million people lost previous coverage at the end of 2013 due to those ACA provisions.

The Congressional Budget Office’s estimated earlier in February that the marketplaces would garner 6 million total enrollees—1 million fewer than projected—due to the websites’ failings.

Other changes in the latest enrollment figures include a slight increase (from 24 percent to 25 percent) in the share of 18- to 34-year-olds who have bought plans in the federal exchanges. The administration was aiming to have 40 percent of enrollees in that age range to ensure the solvency of marketplace plans. 

Workarounds Help Boost Enrollment Figures

The latest enrollment figures appear to underscore the success of the extensive workarounds that federal and state officials, insurers, providers, and others have devised to compensate for ongoing failures of the enrollment websites. Those failures include the lack of a completed so-called back-end for the 36 federally operated websites that allow smooth transmission of enrollment information to insurers. Websites for at least four of the 14 state-run websites remain largely inoperable, according to media reports.

Evidence that demonstrates the ability to overcome those massive technical failures includes Oregon’s progress with enrollments. The state, which has yet to enroll a single resident through the marketplace website it operates due to technical failures, is currently near the middle of enrollment rates nationally. The state has reached 52 percent of its projected enrollments to date, according to an analysis of the latest figures by Avalere, a healthcare consulting firm. Nationwide enrollment reached 55 percent of projections to date, according to the most recent data available.

State enrollments ranged from 17 percent of pre-enrollment projections in Massachusetts to 98 percent of projections in Idaho, Avalere found.

In addition to extensive investment by insurers in extra personnel to process paper applications, providers have launched efforts to supplement government outreach efforts cut short by the website failures. The importance of hospitals in those sign-up efforts was underscored by a January call by the Obama administration for hospitals to step up their sign-up assistance efforts during the final weeks of open enrollment.

Publication Date: Thursday, February 13, 2014