infographic-as-of-3-14A key component of the Patient Protection and Affordable Care Act (ObamaCare) is the health insurance exchanges.  With regard to exchange enrollment, there are both initial government projections and actual outcomes.  The government projections have been a moving target. The Obama Administration initially projected 14 million enrolling in 2014.1 The Congressional Budget Office, however, now predicts just 7 million in 20142 and 25 million by 2018.3 The Administration has since adopted these lower projections.4

Enrollment levels matter.  Low exchange enrollment results in higher premiums for those who do enroll, as the costs of coverage and care are spread out among premium-paying enrollees.  If enrollment is significantly lower than government projections, coverage through the ObamaCare exchanges becomes unaffordable for many of the individuals the Administration promised health reform would help,

There are five steps one must complete to enroll online in an ObamaCare exchange plan:

  1. Visit healthcare.gov or the state exchange website
  2. Create an online account and application
  3. Apply for exchange coverage
  4. Select and enroll in a government-approved exchange plan
  5. Pay the first premium to have coverage begin

The Obama Administration has highlighted the number of Americans that have completed the first two steps.  But it is the number of Americans that complete all five steps for themselves and their dependents that will be measured against the government projections of 7 million enrollees.

The Foundation for Government Accountability (FGA) keeps tabs on actual versus projected enrollment on a state-by-state basis.

Note: Some states are reporting Medicaid and exchange enrollment together, so exchange enrollment is likely lower than reported below. When possible, FGA reports exchange enrollment data independent of Medicaid enrollment data.  

Data last updated March 14, 2014

State
Expected Enrollment in 2014
% of Expected to Pay First Month Premiums
# Paid First Month Premium
% of Expected Enrollment that Selected a Plan
# Selected a Plan
% of Expected Deemed Eligible
# Eligible
Current Population
Total7,000,00015.10%105993360.50%4,234,972125.70%8,796,997307,892,000
Alabama102,3000.00%053.80%55,034131.30%134,3294,727,000
Alaska19,3110.00%034.52%6,66672.40%13,983692,000
Arizona140,4970.00%041.01%57,61197.60%137,0696,487,000
Arkansas 58,3450.00%046.95%27,39599.70%58,1732,894,000
California+ *691,016113.60%785000113.60%785,000172.20%1,190,26037,370,000
Colorado *114,8640.00%076.42%87,776127.00%145,8774,986,000
Connecticut *58,63798.00%5746598.00%57,465146.30%85,8043,529,000
Delaware+ 13,8988.20%114550.32%6,994108.50%15,085893,000
District of Columbia+ *9,52051.30%488768.45%6,516110.50%10,515611,000
Florida501,7490.00%088.11%442,087197.40%990,45518,844,000
Georgia240,2160.00%058.02%139,371142.20%341,6509,587,000
Hawaii *18,6030.00%026.71%4,96959.00%10,9681,308,000
Idaho * 54,8570.00%079.96%43,861135.10%74,0851,558,000
Illinois 236,8100.00%048.03%113,733104.00%246,18812,734,000
Indiana152,0440.00%042.73%64,97295.50%145,1896,368,000
Iowa 62,1390.00%024.70%15,34664.60%40,1133,001,000
Kansas79,1080.00%037.05%29,30982.20%65,0572,765,000
Kentucky+ *88,2050.00%068.97%60,837187.80%165,6844,291,000
Louisiana104,2330.00%043.71%45,561103.10%107,4804,455,000
Maine35,7110.00%071.16%25,412132.90%47,4441,311,000
Maryland+ *91,52822.30%2043941.59%38,07055.60%50,9005,782,000
Massachusetts+ *82,8530.00%015.65%12,9657.20%5,9436,526,000
Michigan 181,9850.00%079.45%144,587172.30%313,6449,724,000
Minnesota+ *129,99923.30%3034925.94%33,72273.70%95,8625,246,000
Mississippi 75,2970.00%033.94%25,55491.10%68,5622,919,000
Missouri159,7330.00%046.62%74,469106.50%170,1805,915,000
Montana37,6260.00%059.91%22,542106.10%39,917980,000
Nebraska52,6910.00%048.55%25,582103.10%54,3111,810,000
Nevada+ *62,37833.60%2093045.75%28,535152.20%94,9262,684,000
New Hampshire 32,4300.00%066.54%21,578133.40%43,2561,298,000
New Jersey167,3950.00%044.43%74,370111.80%187,2318,687,000
New Mexico * 47,0200.00%031.93%15,01275.30%35,4162,028,000
New York *411,3040.00%072.90%299,836129.80%533,94819,218,000
North Carolina268,0860.00%074.81%200,546145.80%390,9259,377,000
North Dakota18,2030.00%028.78%5,23857.10%10,394660,000
Ohio196,6050.00%040.14%78,92598.20%193,15211,327,000
Oklahoma94,0620.00%034.96%32,88283.40%78,4443,718,000
Oregon+ *108,7030.00%041.51%45,11970.10%762233,809,000
Pennsylvania266,8580.00%059.89%159,821147.70%394,15112,621,000
Rhode Island+ *21,82674.90%1634586.60%18,902138.20%30,1581,037,000
South Carolina123,9230.00%045.05%55,830110.10%136,4144,580,000
South Dakota25,5200.00%026.51%6,76562.90%16,047804,000
Tennessee167,9400.00%046.37%77,867121.50%204,0756,294,000
Texas780,9590.00%037.78%295,02597.10%758,34425,340,000
Utah 83,3680.00%047.86%39,90293.90%78,2582,781,000
Vermont+ *15,11694.90%14352160.93%24,326427.70%64,645620,000
Virginia184,5190.00%055.72%102,815136.30%251,5667,822,000
Washington *149,04373.10%10902173.15%109,021132.30%197,2206,711,000
West Virginia 30,6860.00%035.75%10,97081.90%25,1331,821,000
Wisconsin132,7240.00%053.83%71,443119.10%158,0485,659,000
Wyoming17,0760.00%040.04%6,83883.70%14,296555,000

Download the full spreadsheet with sources

 
Source: Foundation for Government Accountability, various public documents
+ = May include Medicaid enrollees and small business applications as well, separated out when reported.
* = State Based Exchange.

Methodology

Enrollment projections produced for the Society of Actuaries with the Lewin Group’s Health Benefits Simulation Model (HBSM) were used to calculate the distribution of exchange enrollees by state. The HBSM projections were modeled for each state with and without the optional Medicaid expansion. States’ current decisions on whether to expand Medicaid were utilized to determine ultimate enrollment in each state. These decisions were reported by the Centers for Medicare and Medicaid Services, as of September 30, 2013. Because the HBSM projections assume ultimate enrollment in the exchanges is immediate, the projections were revised downward to reflect the fact that enrollment will likely phase in over the next few years. National projections of exchange enrollment produced by the Congressional Budget Office were used to revise downward the total enrollment figures.

Given that Medicaid expansion discussions are ongoing, these estimates could change from time to time. The Foundation for Government Accountability is actively monitoring this process and will update these projections to reflect future changes.

Sources:
  1. http://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/NationalHealthExpendData/downloads/proj2010.pdf
  2. http://www.cbo.gov/sites/default/files/cbofiles/attachments/44190_EffectsAffordableCareActHealthInsuranceCoverage_2.pdf)
  3. http://www.cbo.gov/sites/default/files/cbofiles/attachments/44190_EffectsAffordableCareActHealthInsuranceCoverage_2.pdf
  4. http://www.politico.com/story/2013/06/kathleen-sebelius-says-exchange-goal-is-7-million-by-march-93301.html