According to data
 released today from the Arkansas Insurance Department, through March 24, 33,569 people have enrolled in the Arkansas Health Insurance Marketplace, the federally facilitated health insurance marketplace created by the Affordable Care Act. You can see a county-by-county map above. With the official deadline to sign up approaching on Monday (though in practice, people will have more time), enrollment remains well below initial projections. 

This does not include enrollment into the private option, which has had more than 200,000 applications, with around 150,000 being deemed eligible and gaining coverage, as we reported yesterday.


Quick crash course to understand the difference: while private option beneficiaries select private plans available on the Marketplace, there are two different groups using two different enrollment processes:

1) People who make less than 138 percent of the federal poverty level (about $16,000 for an individual or $33,000 for a family of four) are eligible for the private option. The premiums for their plans are fully paid for by federal Medicaid funds.


2) People who make more than 138 percent and who are shopping for individual non-group plans (these are folks that don’t get coverage through their work or through a public program like Medicare) can purchase plans on the Marketplace. If people in this group make less than 400 percent FPL (around $47,000 for an individual, $95,000 for a family of four) they qualify for subsidies via the ACA to help them cover the cost of insurance.

Got all that? The numbers from AID are about Group #2, the people who are shopping on the individual market and make too much money to qualify for the private option. This represents a small uptick from the federal data released earlier this month, which showed enrollment through March 1 at 27,395. So around 6,000 more people have signed up in the last six weeks. 


Enrollment is well below targets. Prior to the ACA, around 250,000 people were estimated to be uninsured and make more than 138 percent FPL, the population that the Marketplace is intended to reach. While no one predicted that all of them would sign up, thus far the 33,569 enrollees represent just 13.4 percent of that eligible population (and some of the Markteplace enrollees may have been previously insured). Heading in to open enrollment, AID set a target of 160,000, though this was inclusive of the Small Business Health Options Program, which ended up getting delayed significantly. Marketplace Director Cindy Crone told me that projections were lowered to around 50,000 once the initial problems with became clear. Any way you cut it, the number of people purchasing plans on the Marketplace is less than what was once projected. While the private option has been a smashing success at reducing the number of uninsured people below 138 pecent of FPL, the Marketplace in Arkansas above that line is so far falling short of the health care law’s goals in terms of getting people covered. See the map at the bottom of this post for more. 

Obviously, it’s still very early in the life of the law, and of course the disastrous initial performance of the website — now largely fixed — surely dampened the numbers (and of course it didn’t help that the legislature squashed the outreach effort just as it was getting off the ground). There’s another big caveat to keep in mind in Arkansas: the Insurance Department’s decision to let people with private plans non-compliant with the new law keep their plans through fall of 2017. Those plans were cheaper for many consumers, both because they often offered skimpier coverage but also because the insurance market prior to the ACA was very good at pricing sick people out. For folks lucky enough to be healthy, many of these plans were great deals, and they’re likely to stick with them, keeping them out of the Marketplace. In testimony before the legislature, carriers have estimated that tens of thousands of Arkansans fall into this boat, meaning enrollment in the Marketplace could spike once these plans phase out (though, of course, this group is not the uninsured but people who were already covered prior to the health care law). 

Enrollment matters because a stable marketplace needs a large mix of people, including a good proportion of healthy people. Here’s where the private option saves the day. Without the private option, the Marketplace would be floundering. But more than 100,000 people have fully enrolled in Marketplace plans via the private option, a number that will grow dramatically in the coming weeks. Now, it’s hardly surprising that enrollment in the private option would be more successful more quickly since beneficiaries don’t have to pay any premiums at all. But in terms of the overall health of the Marketplace, this has been a major policy victory, particularly since the private option population appears to be leaning younger and healthier than the rest of the Marketplace. 

Now, Obamacare opponents might see this as a bug, not a feature, of the private option. Some may be rooting for the Marketplace to collapse. These are the same people who will gleefully chortle if enrollment numbers come in low, or who scream about extensions that will allow more to sign up. But keep in mind that a successful Marketplace with strong enrollment means lower premiums in the long run, more carriers in the state, and more choices for consumers. Problems on the Marketplace don’t hurt Obama, they hurt Arkansans shopping for individual health insurance. 


Given that, you might think that the state would be doing everything it could on the outreach front to ensure that uninsured people knew about their options on the Marketplace. Well…you’d think wrong

Speaking of those options…most of the people who have signed up have qualified for subsidies available via the ACA, making their plans on the Marketplace cheaper than the list price. A whopping 91 percent of Arkansans selecting plans on the Marketplace have qualified for subsidies, according to federal data (that’s through March 1). Nationally, the Kaiser Foundation estimates that 83 percent of Marketplace enrollees have qualified for subsidies, totalling $10 billion. As Kaiser’s Larry Levitt points out, states like Arkansas with lower enrollment numbers are leaving money on the table. 

To show how much work still needs to be done, see the map below from AID, which shows the percentage of people who have signed up for a Marketplace plan among the total eligible uninsured population who make more than 138 FPL, county by county (in other words, this map focuses only on the non-private-option population). 

The Public Health Committee will be meeting shortly to discuss enrollment on the Marketplace, as well as private option progress. I’m about to get on a plane, so won’t be able to report on the inevitable grandstanding.