Just 3 percent of those expected to eventually sign up for Obamacare's state-based health markets in a dozen states running their own markets have actually signed up so far, according to an analysis Monday from a health consultancy that predicted the pace will eventually pick up.
Avalere Health said that by the end of next year, the 12 states are expected to have 1.4 million enrollees in their health exchanges. As of Sunday, though, 49,100 had actually signed up.
"I would expect to see these numbers to grow over time. This happens gradually," Avalere CEO Dan Mendelson said in an interview, citing the slow start to the Medicare drug benefit program during the George W. Bush administration.
The Congressional Budget Office projects that 7 million people would enroll in the health exchanges set up under the Affordable Care Act. Some states elected to set up their own exchanges, but most left the job to the federal government, whose website is supposed to help enroll potential customers but has been plagued by problems since its Oct. 1 launch.
Some states, meanwhile, have reported their own website problems.
Between the federal problems and issues in various state-run markets, there is a "climate of scrutiny and negativity" that may have suppressed enrollment among the states in Avalere's analysis, Mr. Mendelson said.
For weeks, the Obama administration has predicted that enrollment would start slowly and pick up speed by early December, when enrollees race to buy plans in time to gain coverage by Jan. 1. But if slow-enrollment trends continue because of Web glitches or a lack of interest in the exchanges, it could spell trouble for the overhaul.
The D.C. exchange, which is run by the city government in the nation's capital, signed up only 1 percent, or 300 enrollees out of a projected 25,000, according to the analysis. It was the lowest percentage among the 12 exchanges studied by Avalere.
However, a spokesman for the D.C. exchange said Friday they've been "very pleased with the strong, enthusiastic response from the residents and small business owners in the District."
As of Oct. 21, 12,294 city residents had created personal accounts at D.C. Health Link and 321 of them had selected a health plan for enrollment, he said. Since those accounts may include couples and families, the total number of newly covered individuals is likely higher than 321.
Kentucky, the only state-run exchange in the South, has enrolled 4,600 people out of a projected 73,000, or 6 percent, while Washington State boasted 7,300 enrollees, or nearly 7 percent of its 110,000 projected participants, according to Avalere.
Vermont expects to enroll 30,000 people on its state-run health exchange. So far, it has enrolled 3,500, or 12 percent, of its projected participants.
Avalere's figures found that interest in the D.C exchange lags behind states. Just 15,000 people have visited D.C.'s online exchange portal, or 60 percent of the final total enrollment target. Most other states saw much higher levels of interest.
States like Washington and Colorado, meanwhile, are seeing three to four times as many unique visitors to their Web portals as projected enrollees.
Mr. Mendelson, however, said he does "put a lot of stock" in the unique visitors numbers — they could be defined in various ways and were drawn from press releases, interview and news articles — and their implications for eventual enrollment totals.
He also said the enrollment projections are fluid figures that should be viewed with two caveats in mind.
Avalere's projections reflect those who are expected to enroll through an exchange, but it is possible that some residents will opt to pay a tax penalty for failing to gain insurance — a sanction that kicks in during tax filing season in early 2015 because of the law's individual mandate.
In that case, the firm's projected enrollment would fall, Mr. Mendelson said.
Conversely, some of the states listed in the study may adopt the so-called Arkansas model for expanding Medicaid to those making up to 138 percent of the federal poverty level. Under this method, the state uses an influx of federal funds for the entitlement program to purchase private insurance for the newly eligible population, a move that would boost enrollment numbers on the corresponding state exchanges.
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