The Health Insurance Marketplace - Who Is Enrolling?

The United States Department of Health and Human Services (HHS) has now released some interesting data giving us a sense of which Americans have selected a Health Insurance Marketplace  plan by both age and gender and which plan they have selected by level during the first three months of activity.  Here we go.

This graphic shows how enrolment in the Federally-facilitated Marketplace (FFM) ramped up over the three month period:

A total of 1.2 million Americans have selected a plan through the federal Health Insurance Marketplace since October 1, 2013.  An additional 956,000 plans were selected in the State-Based Marketplace (SBM) for a grand total of 2,153,421.  You will observe that, over the first 9 weeks, less than 200,000 individuals enrolled in a plan through the FFM, an average of just over 22,200 a week, a number that is directly related to the website technical issues.  Since that time, roughly 1.05 million enrolments have taken place over a four week period to the end of December.  Interestingly, there were 53.223 million visits to the state and federal websites and 11.266 million calls to the state and federal Call Centres over the same period.  In total, 4.348 million applications were completed through the federal and state Marketplaces.

Here is a gender breakdown of the enrollees:

It's interesting to note that males account for 50 percent of the population between the ages of 0 and 64, meaning that males are relatively under-represented in those that have enrolled in the Marketplace thus far.

Here is a graph showing the type of plan selected:

The vast majority of enrollees have selected a Silver Markeplace Plan which is anticipated to cover 70 percent of a person's health care costs.  In addition, 79 percent of all enrollees will be receiving Federal financial assistance in paying their premiums.  The Congressional Budget Office anticipates that the average exchange subsidy per subsidized enrollee in 2013 will be $5290, rising to $7900 in 2023.

Lastly, here is a graph showing the age breakdown of enrolees:

Young adults between the ages of 18 and 34 account for 24 percent of all Marketplace plan selections, below the 26 percent level that they represent in the overall population.  HHS anticipates that "older and sicker" individuals will tend to enroll earlier while younger and healthier people will have a tendency to wait until the end of the open enrollment period which ends on March 31, 2014.

The number of young people enrolling is critical.  The White House had hoped that 39 percent of enrollees would be within the 18 to 34 age group to prevent insurers from having to cover a significantly higher proportion of high-risk (read "older and sicker") beneficiaries.  This situation could cause a "death spiral" where insurers are forced to raise premiums to cover the additional cost of "older and sicker" individuals, a situation that could make it more difficult for younger and healthier individuals to afford health insurance over the long-term.

According to the Congressional Budget Office (CBO), without the ACA, 57 million non-elderly Americans currently have no form of health care insurance.  From this HHS data release, we can see that the Affordable Care Act has a long way to go before it puts a significant dent in the number of Americans who do not have access to health care insurance.