California health exchange enrolls fraction of target

California's new health insurance exchange tentatively enrolled 35,000 people during its first month of operation, a fraction of the eventual goal in the state with the nation's largest uninsured population, federal health officials said Wednesday.

A report released by the U.S. Department of Health and Human Services provided the first glimpse into the operations of Covered California, which faces a monumental task to reach millions of people without insurance and sway them to sign up under the federal Affordable Care Act.

The report, covering the start of open enrollment on Oct. 1 through Nov. 2, also showed that about 80,000 lower-income people would be eligible for expanded Medicaid coverage under another prong of the overhaul.

California counts nearly 7 million people without health coverage. An estimated 2.3 million are expected to enroll in a health plan through the new agency, known as Covered California, by 2017.

The 35,000 figure was defined in the federal report as the number of people who have “selected” a plan through the insurance exchange. According to HHS, that means the number of people who have chosen a specific insurance plan, whether or not they have actually followed through and begun paying the premium for it.

Covered California said sign-ups have accelerated since then, to about 2,400 people a day so far this month.

“The numbers are better than encouraging,” Peter Lee, the health exchange's executive director, said in a statement. “They show momentum and very high consumer interest.”

The report provided no detailed information about those buying plans or what types of plans they selected. For example, it did not say what percentage of those who have selected plans were in the younger and healthier demographic that is sought by insurance companies to balance out those who are sicker and more expensive to cover.

In addition to the state-by-state numbers, the Health and Human Services report also provided the overall figure for national enrollment under President Barack Obama's national health reforms.

It said that fewer than 27,000 people managed to enroll for health insurance last month in the 36 states relying on the problem-filled federal website. States running their own websites, including California, did better than the federal government, together reporting more than 79,000 sign-ups.

Even so, total private insurance enrollment after the first month of the health care rollout was only about one-fifth what the administration had expected during that time period.

Enrollment numbers nationwide totaled 106,185. A Sept. 5 administration estimate had projected that 494,620 people would enroll in the first month.

Critics of the federal health care overhaul and its implementation seized on the relatively paltry sign-up numbers and the fact that the federal government and California provided no details about who was signing up. If healthy people avoid buying insurance on the exchanges, it will undermine insures' business model and ultimately force premiums higher.

During a Wednesday news conference, Lee said Covered California will have a breakdown of its enrollees next week. He said they tend to be “older than average” and are those who previously could not get any health insurance.

If that trend holds, those who sign up for insurance on the exchanges this year are likely to face sticker shock in 2015 when their policies get more expensive, said Republican state Assemblyman Dan Logue, who represents a district north of Sacramento.

“Covered California is giving you the best-case scenario, but where's it going to be 12 months from now?” he said. “I'm pretty sure it's going to be unsustainable.”

He also noted the 1 million people in California whose individual health insurance policies are being canceled because they don't meet the requirements of the Affordable Care Act.

“We have more people that don't have health coverage now than have signed up under Obamacare because they've been kicked off their plans,” he said.

The launch of the Affordable Care Act, also called “Obamacare,” has been plagued by technical problems with the federal government's website. Several states that run their own exchanges, including Oregon and Hawaii, also have experienced significant technical setbacks that have prevented people from signing up.

At the same time, millions of Americans who buy individual policies are receiving notices from their insurance companies saying their policies will be discontinued because they do not meet the higher standards of the federal law. That is despite Obama's promise that people could keep their current policies if they were happy with them.

Most Americans receive health insurance through their workplace and are largely unaffected by the new health care exchanges.

Under the president's program, people without access to coverage through their jobs can shop for subsidized, private insurance in the state marketplaces, or exchanges. The benefits begin Jan. 1.

Another major piece is a Medicaid expansion to serve more low-income people. Not all states have accepted the expansion, partly because of concerns over the future cost.

The problems with the exchange websites and confusion over the law led Obama administration and state officials to lower expectations for the early enrollment numbers.

“We were always expecting October would be a month when people would do some comparative shopping but not necessarily go through the entire process,” said Anthony Wright, executive director of Health Access California, an advocacy group for the needy working closely with Covered California. “You don't necessarily buy a car on the first trip to the lot.”

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