The administration’s goal is to enroll about 7 million people in the first year, and about 40 percent of those enrollees need to be young, healthy consumers. Bringing young people into the system is critical to keeping premiums low and avoiding an insurance “death spiral.”
Hitting that mix across 7 million Americans isn’t good enough, though. Each state has to get the right ratio in its own insurance market.
“All of this is very state-specific on how it plays out,” said Edwin Park, vice president for health policy at the Center on Budget and Policy Priorities.
The 36 states using HealthCare.gov are often lumped together because their exchanges are all run by the federal government and they’re all beholden to the same broken website. Countless reporters and Republicans have pressed HHS for enrollment figures for the federally run exchange, as if it’s one unit.
But each state does still have its own insurance market and its own risk pool. Enrollees aren’t pooled with any other state, whether they run their own exchange or not…
A nationwide enrollment total, pulling together all 50 states, would give the health care world a sense of “how far behind we are” because of HealthCare.gov’s woes and the technical problems with some of the 14 state-run exchanges, Frakt said. Beyond that, he said, it’s all but useless. One total for the 36 states using HealthCare.gov wouldn’t be much better.