Obamacare Enrollment Heads for 17 million

by Maggie Mahar at The Health Beat Blog.

Charles Gaba, who has become the “Nate Silver” for Obamacare enrollment numbers; now predicts that by April 15, 17 million Americans will have purchased their own healthcare coverage.

His back-of-the-envelope estimate includes a nice round 8 million”  who buy policies in the government marketplaces. In parentheses, he suggests:  Perhaps a little higher (1M even?) and then strikes that thought;  “As always,” he notes, “I’ll be more than happy to be proven wrong, as long as I’ve undershot the mark.”

Gaba then adds roughly  9 million who, (according to a Rand Corp. survey), have bought their own policiesdirectly from insurers, instead of using the Exchanges. Nine million plus 8 million brings us to an astounding number: 17 million.

Rand shared its analysis  with the LA. Times, though it has not yet released its report. Obamcare’s  skeptics scoff at Rand’s number; but, Gaba points out the Blue Cross and Blue Shield Association alone have confirmed its member plans have enrolled at least 1.7 million people in plans that  meet the ACA’s requirements outside the exchange system.

Gaba acknowledges “Rand didn’t come out and say that the 9M figure was absolute; they just based it on a survey with percentages. Surveys include margins of error, so it could be only 8M, or perhaps 10M, or maybe a bit higher or lower.

Gaba has gained his reputation by being meticulous—and cautious. Typically, his estimates have been conservative. Given that track record, my guess is that by April 15, we will find that at least 17 million Americans have bought their own policies.

At this point, you may be wondering: But don’t we need the roughly 9 million Americans who are purchasing policies directly from insurers to join the state marketplaces in order to spread the cost of Exchange coverage among as many people as possible?

The answer is “No.”

Here is another little-known provision in the ACA: Under  the reform law, if a carrier sells policies to individuals both in the state marketplace and in the private market, the insurer must view those customers as part of one risk pool, and price their policies accordingly.  The 17 million share the risk of becoming sick, while also sharing the cost of insurance that guarantees everyone access to care. All other things being equal, the larger the pool of people who buy coverage both on and off the Exchanges, the lower the risk– and the lower the cost for all of them.

“All other things being equal” includes whether the new people jumping into that pool are healthy. Recent evidence suggests that the new entrants are, in fact, younger, and as a result, more robust than  those who signed up earlier. The numbers suggest that this is particularly true of  the 9 million who bought their insurance off-Exchange.

Cross posted at: The Health Beat Blog