Don’t expect big enrollment numbers for the health insurance exchanges

The federal government promises to release the first official estimates this week of just how many people have managed to buy health insurance on the new online exchanges. By every indication, it won’t be many.

Health and Human Services Secretary Kathleen Sebelius played down expectations last week when she testified before a Senate committee. "I can tell you our early enrollment numbers will be very low," she said.

The federal website’s technical troubles are mostly to blame — but that may not be the whole story. Health consulting company Avalere Health released an analysis Monday that suggested just 3 percent of those eligible to sign up on the state-run exchanges have done so, and that includes states whose exchanges are working well.

“Enrollment in new programs begins slowly and often takes several months to build momentum,” said Dan Mendelson, chief executive of Avalere Health. “While initial enrollment has been lagging, with aggressive marketing there is still time for awareness of the program to grow and participation to begin.”

Avalere looked at publicly available data on who’s signed up in 12 of the states that have opted to run their own exchanges, plus Washington D.C. They include Kentucky, whose site has been praised as an example of one that works well, New York, which also boasts eager enrollment, as well as Hawaii, whose site got off to a very slow start.

“Together, the 12 states have enrolled 49,100 people in exchanges based on data released by the states, as of Nov. 10. By the end of 2014, Avalere projects these states will account for 1.4 million exchange enrollees,” the company said in a statement.

The federal government is running the exchanges in most of the states — 34. Avalere looked at all the rest, except for California, Idaho, New Mexico and Massachusetts. They include Colorado, Connecticut, the District of Columbia, Hawaii, Kentucky, Maryland, Minnesota, Nevada, New York, Oregon, Rhode Island, Vermont, and Washington state.

Rhode Island and Vermont are the frontrunners, percentage-wise. Rhode Island has signed up 3,800 people, or 11 percent of those expected to eventually enroll, and Vermont has enrolled 3,500 or 12 percent.

One the other extreme, just 300 people or 1 percent of the expected total have managed to sign up in Washington D.C. , and 400, or 2 percent, in Hawaii, Avalere’s analysis found.

The federal government is pushing budget projections that 7 million people will sign up for health insurance on the exchanges next year, and another 7 million to 9 million will enroll in expanded Medicaid.

Kentucky says it’s enrolling 1,000 people a day, mostly into Medicaid. Kentucky is running its own exchange for people to buy health insurance, and is also expanding its Medicaid program to cover more people. The state says 33,561 have enrolled in Medicaid and 7,011 have enrolled in private insurance. And it says 16,425 have been found eligible for a federal subsidy to buy health insurance with but most of them have not yet chosen a plan.

The Advisory Board Company used a different method and has looked at 15 states to estimate enrollment. It finds that 485,026 people have applied and 195,227 enrolled.

“More than one month after launch, we've stopped tracking the number of accounts created for each exchange, as it's an imperfect measure of enrollment and interest. (In some cases, the same would-be applicant attempted multiple accounts in an effort to overcome technical problems or simply window shop),” the Advisory Board Company says.

The Centers for Medicare and Medicaid Services, which runs the new federal health insurance exchanges, has promised they’ll be running smoothly for most users by the end of the month. CMS and HHS have also stressed that people will have until Dec. 15 to sign up to get coverage on the first possible day, Jan. 1, and until March 31 to sign up for next year.

Congress is still pushing to find out how the federal exchange got off to such a balky start. Five hearings are scheduled this week, including one Wednesday by the House Oversight Committee where members hope to grill several federal technology experts, including U.S. Chief Technology Officer Todd Park.

The White House has pushed back on that one, saying Park is too busy fixing the exchange to stop what he’s doing and prepare for hours of testimony. 

Some technology officers are backing the White House on this — they’ve created a website called Let Todd Work. They include Adam Becker, chief technology officer of the California company Dept. of Better Technology; former White House art director Michael Aleo; and Clay Johnson, who helped found Blue State Digital, the company that managed President Barack Obama's online campaign in 2008.