Counting Who's Bought Into Obamacare Is Tougher Than You Think

What does it mean to be enrolled in Obamacare? The administration says nearly 27,000 people signed up for coverage through HealthCare.gov in the first month. But that number includes people who picked a plan but haven't made a payment yet. The insurance industry says someone is enrolled only after the first premium payment. Using that standard, the enrollment numbers would be even lower. But the law's defenders say it's unrealistic to expect enrollees to pay three months before their coverage begins.

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The Obama administration announced yesterday that about 106,000 Americans signed up for health coverage last month, the first month of the health care law's enrollment period. Because of the problems with the federal online exchange, that number was far lower than expected. The administration has also been criticized for including people in that number who have signed up but haven't paid yet. Some Republicans have called this Enron-style accounting.

NPR's Chris Arnold reports on what's actually required when someone picks a plan.

CHRIS ARNOLD, BYLINE: There's been a lot of commentary flying around on blogs and news coverage about counting people as enrolled who haven't paid yet. One common account is that anyone who selected a plan and dropped it in their online shopping basket, that they get counted as being enrolled. That would be a pretty flimsy criteria since a lot of people put stuff in online shopping baskets at, say, Amazon.com and then they don't end up buying. But that characterization is not actually true. We wanted to see exactly what threshold the federal government and states are using to count these numbers.

So I click, put this in my basket and then I go to this page. Now am I considered enrolled yet?

LEANNE MULLINS: No.

ARNOLD: That's LeAnne Mullins, the lead solution coordinator for the state of Kentucky's online health exchange. She agreed to walk me through the process of signing up for health care on my computer, to show me exactly at what point I'd be considered enrolled.

OK, so just by putting something in my shopping basket, in the system you're not counting as somebody who's actually signed up.

MULLINS: That's correct.

ARNOLD: This process is very similar on the federal website, too. In order to be considered enrolled you have to go through a series of additional steps.

MULLINS: OK. You click continue sign and then you go to a sign and submit page. And on that page it basically tells you all the rights and responsibilities.

ARNOLD: On both the Kentucky site and the federal site you have to do an electronic signature. There are then additional steps to confirm all this. And then one big final button to submit all your personal information to an insurance company, to enroll in a specific plan

MULLINS: Yes. And then it gives you the option to pay now or pay later. If you click pay now, you actually go to the issuer's website and you make a payment through there website.

ARNOLD: The government says it actually doesn't have the data from the insurance companies about how many people chose to pay. But it's probably a safe bet to assume that a large number of people decided to pay later. And, of course, some of those folks who haven't paid are more likely to opt out or change their mind. So these numbers from the administration, to some degree, must overstate the true enrollment.

But at the same time, if they had just counted those who paid up in advance that would understate enrollment. So either way, we wouldn't know how many people who signed up in October will actually follow through and get coverage.

Chris Arnold, NPR News.

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