Enrollment Shifts in Reform Implementation

A quick refresher on the Congressional Budget Office projections for where people would be getting health care coverage as reform was implemented is helpful as we get our first glimpses at reality, one source of which is a new Mark Farrah Associates brief.  (MFA Report)   CBO estimated 6 million people getting individual coverage through the exchanges, one million losing individual coverage outside the exchanges, 7 million new Medicaid enrollees and about a half million decline in employment-based coverage, all in 2014.  Although sold as money-saving, the CBO now says all this will cost a net $36 billion.  Based on state filings, Mark Farrah found that enrollment in individual plans increased by over 2 million people from first quarter 2013 to first quarter 2014.  As a side point, WellPoint is the market leader in this segment with over 2 million enrollees.  Managed Medicaid membership grew by 5.5 million, with WellPoint again the market leader.  Risk-based employer plan enrollment dropped by 4.6 million in this time frame, while self-insured employer plans grew by more than one million.  UnitedHealth Group is the leader in both these segments.  Notice the disconnect with the “official” enrollment reports from the Administration.  CBO estimated 5 million net new enrollees for individual coverage, the Administration claims that 8 million enrolled through the exchanges and won’t say how many people it thinks lost or gave up existing individual coverage.  The Mark Farrah numbers suggest a net change of only 2 million.  Now maybe there are some missing state filings, but these numbers are usually pretty close to accurate.  Coupled with ongoing reports of worthless data and incomplete enrollments in the exchanges, maybe the real number of exchange enrollments is closer to 2 million.  However it works out, for example if 8 million did enroll through the exchanges but 6 million lost existing coverage or if 4 million enrolled and 2 million lost existing plans, on a net basis no where near the projected drop in the uninsured has occurred.  And note that in this data, employment-based coverage drops by a net 3.5 million, far more than CBO projected, at a time when the number of people employed has been growing.  More accurate numbers will presumably be received as the year goes on, but right now some interesting questions are being raised.