REPOST: Helping & hindering in the home stretch

(I posted a version of this a week ago, but figured I should repost it now that we're actually into the final month)

This morning I posted my final projection for February enrollments of 902K Private QHPs, for a total of 4.2 million as of March 1st.

Along with this, the enrollment projection model also gives a range of possible final QHP tallies through the end of March, ranging from 5 to 7 million depending on a variety of factors:

As you can see, the possibilities are pretty clean:

  • If March ends up being similar to January & February (around 32,000 per day), the final number will end up being around 5.2 million.
  • If March ends up being similar to December, which had a huge "surge" in the last 2 weeks (64,000/day), the final tally should be around 6.1 million.
  • If, however, March ends up with a massive surge that outperforms December by 50% (96,000/day), the final tally should be around 7.1 million.

Here's a list of the forces supporting and opposing higher or lower enrollment going into the final 6-week stretch:


  • Technical Improvements: 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.
  • The Outreach 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 administration itself is heavily involved, with the President & Mrs. Obama themselves, along with Vice-President Biden, HHS Director Kathleen Sebelius and other top officials joining in the push.
  • 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 Problems: Healthcare.Gov was partially offline for 3 days last month for scheduled maintenance, and was also partially offline for 4 days after something went wrong during scheduled maintenance. Fortunately, both of these have been resolved and both sites are back online...but with only 30 days to go, any additional major problems (on top of the ongoing problems in some of the state websites, such as Oregon, Hawaii and Massachusetts) could be disastrous.
  • 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 70% 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...