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Obamacare's National Enrollment Looks OK, But States Matter More

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Obamacare's National Enrollment Looks OK, But States Matter More


Obamacare's National Enrollment Looks OK, But States Matter More

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  • <iframe src="" width="100%" height="290" frameborder="0" scrolling="no" title="NPR embedded audio player">
  • Transcript


It's MORNING EDITION, from NPR News. Along with Renee Montagne, I'm Linda Wertheimer.


And I'm Steve Inskeep.

The Obama administration says it hit a target under the Affordable Care Act. Six million people signed up for health insurance. Many experts have been watching that number, and they're also asking what percentage of those people are younger and healthier. But as the deadline nears for enrolling in Obamacare, let's ask what the numbers really mean.

Here's NPR's Julie Rovner.

JULIE ROVNER, BYLINE: Six million. That's the number the Congressional Budget Office expected would sign up for insurance through the federal and state health exchanges. And 40 percent of those should be between the ages of 18 and 34, insurers hope. The theory is those younger people will also be healthier, and offset the costs of older and sicker people.

But many experts, like Caroline Pearson of Avalere Health, a Washington, D.C. based consulting group, say those numbers don't really mean very much.

CAROLINE PEARSON: Six million and the percent of young adults are easy numbers for politics, and politics sometimes struggles with the more nuanced issues that really matter for the underlying policy.

ROVNER: Pearson says looking at national numbers doesn't make much sense, because there is no national insurance market.

PEARSON: You have to look at each of the states and what is happening at their unique setup.

ROVNER: Seth Chandler, who teaches insurance law at the University of Houston Law Center, says some states are doing quite well at signing people up.

SETH CHANDLER: California, New York, Connecticut, Vermont.

ROVNER: California by itself has enrolled more than 850,000 people, and New York nearly 350,000. Meanwhile, Chandler says, other states are lagging seriously behind.

CHANDLER: Including the big state of Texas and states such as Louisiana, Arizona, Mississippi, Oklahoma.

ROVNER: The problem is that because each insurance market is run within each individual state, the big numbers in some states don't make up for shortfalls in others.

CHANDLER: The fact that New York doesn't experience problems in its health insurance market and insurers aren't being squeezed there does nothing whatsoever to help insurers and people in Texas, Louisiana and elsewhere, where it looks like, at least, too few people are enrolling to have confidence in the success of the marketplace.

ROVNER: And it's not just an issue of the total number of people signing up in each state, or whether they're young or old. Karen Ignagni, who leads the insurance trade group America's Health Insurance Plans, says the real issue is the balance of healthy-to-sick individuals. She said in a C-Span interview last week that health plans are already seeing an influx of sicker people, thanks to new rules that bar health plans from discriminating against people with preexisting health conditions.

KAREN IGNAGNI: We see a number of people who have gotten into the program, in January in particular, who are using a number of health care services. That's to be expected. No one in our industry thought that it would be any different. We thought that the people who needed services immediately would be the first to be motivated to sign up.

ROVNER: The big question, she says, is whether the last-minute enrollment surge that appears to be taking place now will be big enough and full of the right kind of people.

IGNAGNI: We thought that the people who were healthier, who didn't feel like they needed services immediately, would be at the end of the process. And we're hoping that that hypothesis is going to be true.

ROVNER: But there's yet another factor the overall numbers don't take into account. That's what insurance companies expected would happen when they set their premiums for this year. And law professor Chandler points out that's something we really don't know.

CHANDLER: Was the pricing any good to begin with? Were they too conservative in their estimates of the population? Were they too liberal? There are all these factors that we do not know yet that are going to determine, as much as the raw enrollment numbers, how insurers react for 2015.

ROVNER: The bottom line is that what happens to individual insurance markets in each state after this first open enrollment season is going to depend on a lot more than just one or two numbers.

Julie Rovner, NPR News, Washington.

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