(Updated) ENDGAME: Helping & hindering going into the home stretch

Yesterday I posted an analysis of the current enrollment trends and gave a range of possible final QHP tallies through the end of March, ranging from 5 to 7 million depending on a variety of factors. However, I didn't really go into what those factors actually are, so here's a simple list of the forces supporting and opposing higher or lower enrollment going into the final 6-week stretch:


  • Technical Improvements: HC.gov has been operating pretty smoothly since around mid- to late November, and technical issues at some of the state-run exchanges have improved substantially; even Cover Oregon managed to enroll about 700 people using their website (a first for the state...up until now, the 35K or so enrolled have all been done manually), although those still had to be done by qualified agents, not regular the customers themselves
  • Backlogs Being Processed: Whether due to technical problems being fixed or the states simply bringing in a huge number of bodies to process them manually, tens of thousands of paper applications which have been piling up in Oregon, Massachusetts and other states are finally being processed through the system.
  • Enroll America's Ground Game: There's been a massive push by groups such as Enroll America and Planned Parenthood to have thousands of canvassers and navigators comb the streets of America in a campaign-turnout-like outreach effort to make people aware of their options and the urgency to enroll before the end of March.
  • The Ticking Clock: Plenty of people simply have a tendency to wait until the last minute; they're planning on enrolling sooner or later...and have simply decided to wait until later...but will finally go through with the process as the deadline approaches.
  • The Tax Refund Factor: This could help in two ways. First, there should be a small windfall check showing up in the mail for quite a few people over the next month or so: Early tax return filers receiving their refund. These are people who are a bit more tech-savvy anyway, and now they have a few hundred/thousand dollars in hand which will hopefully make them more likely to take the ACA plunge. In addition, I've been informed that those who file electronically will receive an exchange/eligibility reminder during the filing process, which I wasn't aware of previously.


  • NEW Technical Problem #1: Healthcare.Gov was partially offline for 3 days last weekend for scheduled maintenance. Enrollments could be started but not completed during that period. When there's only 45 days to go, losing 3 days on the site responsible for 36 states hurts (that's 6.7% of the potential enrollment time).
  •  NEW Technical Problem #2: Similarly, the enrollment section of CoveredCA.com has been offline since Wednesday the 19th, and is still offline as of this writing on Sunday night. This stings, as until last week California was kicking major ass enrollment-wise, and just kicked off a huge enrollment PR campaign of their own. If they get it back up and running by tomorrow morning, they'll have lost 4 days out of the final 40, or 10% of the remaining time...and if they're not back online by the morning, ouch. (Update: OK, as of 10:00am 2/24/14, CoveredCA's enrollment system does appear to be back online).
  • The Low-Hanging Fruit Is Gone: There are two groups that were the most likely to enroll early: Those who have been trying to get insurance but have been denied based on pre-existing conditions, and the "OMG 5M CANCELLED!!" crowd (ie, those who already had coverage which was cancelled for not being ACA-compliant, which includes my wife and myself).
    ​The vast bulk of both of these groups have already signed up by now, either via the exchanges or directly, as witnessed in New York, which has jumped from 50% previously uninsured to 66% to 69% in just the past few weeks. In other words, we're now down to those who have never actually had insurance...which also means those with the least amount of experience in how insurance works, as well as those who may still be completely in the dark about the exchanges, why they should enroll, the penalty for not doing so and so forth. These are going to be a much tougher nut to crack.

So, which of these (positive or negative) will become a factor in the final weeks, and how much of one? Hang on, it's gonna be a bumpy ride...