A small group of demonstrators stand outside of the HIlton Hotel and Suites prior to former South Carolina Senator Jim DeMint, president of the The Heritage Foundation, speaking at a "Defund Obamacare Tour" rally in Indianapolis August 26, 2013. (REUTERS/Nate Chute)
October’s dismal Obamacare enrollment numbers were tempered by a bright spot for the White House: 1 million Americans who took the trouble to fill out an application on the tech-plagued site but have not yet picked a plan.
A paltry, far-under-target 106,000 people nationwide actually selected a private insurance plan by putting it into their online shopping carts last month. But the Obama administration stressed that 975,000 other Americans who filled out applications online would soon join their ranks. The White House needs 7 million enrolled by the end of March.
“There's no question that if the website were working as it's supposed to, that number would be much higher of people who've actually enrolled,” Obama said at a press conference last week.
The president argued that the number of people who filled out fairly lengthy applications shows there is “a real demand for quality, affordable health insurance.”
But it’s far from clear that the hundreds of thousands of people who went through the steps to apply for coverage will actually ever complete the process. While the website problems undoubtedly deterred some people from enrolling, most of the glitches were concentrated at the application — not enrollment — stage.
That leaves open the possibility that customers are balking at the price they’re being quoted when they finish their application — not glitches.
One such person is Jessica Sanford, a Washington state single mom whom Obama cited in a speech as an example of someone who would benefit from the exchange. Sanford was later notified by the state that it had miscalculated her tax credit for purchasing insurance, which made the insurance plan too expensive for her to buy.
“I am so incredibly disappointed and saddened,” she wrote on the exchange’s Facebook page.
“You cannot underestimate the rate shock,” said Bob Moffett, a health care expert with the conservative Heritage Foundation think tank.
But many health care experts think the delay is more about people taking their time before making a big decision, not about price. People who went to the trouble to fill out the application online — despite the hourslong wait due to glitches — will eventually select a plan, they predict. The White House admitted that only three out of 10 people who tried to access the website in its first weeks were able to get through.
“They want to get 7 million people signed up. If they got a million in a first month even with all these delays ... [they are] pretty much on track,” said Karen Pollitz, a health care expert with the nonprofit Kaiser Family Foundation. “I think if people went through all the trouble to figure out eligibility, they must be serious. Nobody has that much time to waste.”
The most common reason people visited an exchange website but did not enroll in a plan was that they were “not certain they could afford” it, according to an October survey of uninsured adults by the nonprofit Commonwealth Fund. The second and third most common responses were that they were still trying to decide which plan they wanted and that they thought the deductibles and co-payments were too high.
Of the respondents, 37 percent said technical difficulties were the reason they didn’t choose a plan.
Even so, Sara Collins, a vice president at the Commonwealth Fund, said the high number of people who went through the application process is an encouraging sign for the Obama administration.
“That’s a really important number,” Collins said. “It shows people’s determination to at least begin the enrollment process.”
The White House has argued that people tend to put off making a big purchase like health care until the last minute, because they want time to weigh their options. Jon Kingsdale, who ran Massachusetts’ health reform marketplace, told reporters last week that insurance is a “tough sale.” When Massachusetts instituted its health care reform in 2006, state officials found that only one out of every 18 people who browsed the insurance exchange website actually enrolled in a plan.
“It’s a grudge buy, and so there’s going to be a lot of browsing,” he said.
But clearly people are procrastinating more in some states than in others.
Fourteen states are running their own exchanges — the rest rely on the problem-plagued HealthCare.gov site. Interestingly, 21 percent of people on these state exchanges who were determined eligible to enroll in a marketplace plan did so in October. But only 4 percent of those who were found eligible in the federal marketplace selected a plan.
It’s unclear if more of the state customers were moved to take the next step and enroll because their website experience was smoother or because the premiums they were offered were cheaper. Many of the states that operate their own exchanges have more insurance companies offering more plans, which helps to drive prices down.
The White House will find out soon if its theory that glitches and procrastination are slowing enrollment is correct. It predicts a surge of enrollees before the Dec. 15 deadline to buy coverage that begins Jan. 1.