Focus on marketplace enrollment overlooks millions who bought private insurance
Want to know how many people have signed up for private insurance under Obamacare? Like the health care law itself, the answer is exceedingly complicated.
The Obama administration is tracking the number of plans purchased on the federal website healthcare.gov and on the state marketplaces, and this month reported that the effort had exceeded expectations by signing up 7.5 million people. In addition, federal officials have said that 3 million people have enrolled in Medicaid since October.
But often overlooked is that enrollment in private health plans outside the marketplaces is also booming. The federal government hasn’t been counting the number of people who buy new plans directly from insurance carriers -- and that number could be substantial.
When Alaskan insurance broker Joshua Weinstein wanted to sign someone up for health insurance this year, he asked one key question -- would they qualify for a federal subsidy? If they did, it was worth signing up through healthcare.gov to make sure they got that substantial reduction in the cost of the monthly premium. But if they made too much money to qualify for a subsidy, he steered them away from healthcare.gov.
"If you can avoid that whole level of bureaucracy and get a good plan -- not necessarily at a good price, but at the same price -- and they're not eligible [for a subsidy], we're going off the marketplace," Weinstein says.
One of those clients is Oliver Korshin from Anchorage. Weinstein and Korshin worked together to enroll Korshin's wife Rachel in a new health plan. She didn't qualify for a subsidy so they went directly to the insurance firm Premera Alaska.
"The actual enrolling wasn't difficult at all," Korshin says.
Weinstein estimates that about 15 percent of his clients are signing up for insurance outside the exchanges. He says enrolling directly with insurers is easier because they don't need the financial information that’s required on healthcare.gov.
"It's basically gathering demographic information -- name, address, phone number, Social Security number," Weinstein says. Essentially, once the clients decide which plan they want, and how they want to pay the monthly bill, they just sign the application, he says, "and off you go."
Alaska's two main insurers say more than 20 percent of their customers in the recent open enrollment period bought plans from them directly. But these customers aren't being tallied by the Obama administration.
Larry Levitt, a senior vice president at the Kaiser Family Foundation, says there's a lot of focus on the 7.5 million people who signed up through the 14 state exchanges or HealthCare.gov. But the off-exchange number is just as essential to gauging how well the law is working, he says. "I think it's probably the case that there are more people insured in the individual market off the exchange than on the exchange right now.” (Kaiser Health News is an editorially independent program of the Kaiser Family Foundation.)
In fact, a new survey from the RAND Corp. estimates 7.8 million people nationwide bought health insurance between September and mid-March directly from a carrier.
This story was updated at 1:50 p.m. to correct the spelling of Oliver Korshin's name.
Kaiser Health News is an editorially independent news service. It is a program of the Kaiser Family Foundation, a nonpartisan health-care-policy research organization unaffiliated with Kaiser Permanente.