All told, 106,185 people selected a plan through one of the government-run marketplaces between Oct. 1, when open enrollment began, and Nov. 2, Health and Human Services (HHS) Secretary Kathleen Sebelius announced Wednesday.
Only one-quarter of them, or 26,794 people, came via HealthCare.gov, the buggy (but improving) federally run website that serves residents of 36 states. The rest, or 79,391 people, came from the remaining 14 states plus the District of Columbia that run their own sites. California alone accounted for 35,364 enrollees.
These numbers are substantially lower than the administration’s original estimate that 500,000 people would sign up in the first month. But they are hardly surprising, given the problems with HealthCare.gov and some of the state-run exchanges. More important, they do not necessarily portend doom for the Affordable Care Act, say health industry analysts.
“We learned what we already knew,” says Caroline Pearson, a vice president at the consulting firm Avalere Health. “For starters, the website has not been working well.”
She points to the difference in enrollment numbers between HealthCare.gov and the state-based marketplaces, which speaks to the number of people who went to the federal site and failed to get anywhere.
“There’s been so much bad press, it’s probably depressed the number of people who have actually been trying,” Ms. Pearson says. “Second, we knew all along that people were going to be slow to enroll and would wait until closer to the deadline, and closer to when their coverage could actually start.”
Consumers must enroll by Dec. 15 for coverage that begins on Jan. 1, but people have until March 31 to enroll in health insurance without paying a penalty.
In addition to those who enrolled in private health insurance, another 975,407 people have been deemed eligible to get insurance through the marketplace but have not yet selected a plan, HHS reported. Also, 396,261 Americans qualified either for Medicaid or for the Children’s Health Insurance Program in the Affordable Care Act’s expanded eligibility for those programs.
But far more important than enrollment numbers during the first month is the question of whether HealthCare.gov will be working more or less smoothly by the end of November, as emergency manager Jeffrey Zients has promised. In recent days, Mr. Zients has suggested the site might not be as far along as he had hoped. Still, HHS said Tuesday that it would start sending e-mails to people who had been frustrated in their efforts to create accounts at HealthCare.gov, encouraging them to try again.
At a congressional hearing Wednesday, the HHS official who led the technical design of HealthCare.gov said the site will perform much better by the end of the month.
“HealthCare.gov will be greatly improved for the vast majority of users by Nov. 30,” said Henry Chao, deputy chief information officer of HHS’s Centers for Medicare and Medicaid Services.
The administration is also trying to reassure consumers that the site is secure and will not compromise their personal data.
But perhaps the biggest challenge the administration faces is the blowback against President Obama over his repeated promises that people who liked their plans could keep their plans. Some 4 million policy cancellations later, Mr. Obama is under intense bipartisan pressure to put in place a fix that would allow him to keep that promise. Former President Clinton’s statement Tuesday might have been the unkindest cut.
"I personally believe, even if it takes a change to the law, the president should honor the commitment the federal government made to those people and let them keep what they got," Clinton told the website Ozy in an interview.
Five Democratic senators have signed on to legislation proposed by a fellow Democrat, Sen. Mary Landrieu of Louisiana, that would allow people to keep their plans. Similar legislation is in the works in the House.
White House press secretary Jay Carney said Wednesday that Obama is about to address the matter.
“You can expect a decision from him and announcement from him sooner rather than later on options that we can take to address the problem,” Mr. Carney said.