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A lot of numbers were thrown at us when the White House finally announced on Nov. 13 how many individuals had signed up for health care coverage through online marketplaces. The general consensus, including from many Democrats, is the early returns were underwhelming.
Still, there was a lot of confusion. How many successfully navigated through the error-laden federal marketplace website? Who actually purchased coverage? Where does Medicaid fit into all of this?
Rep. Debbie Wasserman Schultz, D-Fla., tweeted a simple breakdown.
"This week we found out 500,000 people have signed up for #Obamacare," the chair of the Democratic National Committee said. "It's good news, but we have more work to do."
But is that an accurate overview, or did she oversimplify it? We decide to break it down ourselves.
To the numbers
The U.S. Department of Health and Human Services has the statistics of who signed up in the first month:
From Oct. 1 to Nov. 2, 1,509,883 people applied for coverage through a federal or state marketplace.
Of those individuals, 106,185 approved applicants actually picked an insurance plan — 79,391 through a state marketplace and 26,794 through the federal marketplace.
About a quarter of the people who applied, or 396,261, were told they were eligible for Medicaid or the Children’s Health Insurance Program.
Wasserman Schultz’s office said her tweet came by adding those who picked a private insurance plan to those deemed eligible for Medicaid. And it’s true, adding those two figures together gets us 502,446.
But have those people "signed up for Obamacare"?
President Barack Obama didn’t put it so bluntly. Instead, at a Wall Street Journal CEO Council meeting Nov. 19, he said "About half a million Americans are now poised to gain health care coverage beginning Jan. 1." (Wasserman Schultz’s camp said they were simplifying matters to meet Twitter’s pesky 140-character limit.)
We should note here that Obamacare is a complex law with many moving parts, not a single government program in which people enlist. (Wasserman Schultz knows that, but the average voter might not.)
The Medicaid element in particular adds a perplexing twist. Medicaid is an existing state-federal health insurance program largely for the poor. The health care law allows states to expand Medicaid eligibility, and some states are doing that, while others aren’t.
According to the Department of Health and Human services, about 400,000 individuals were "determined or assessed eligible for Medicaid or CHIP," but are they actually signed up? Does the applicant have to take additional steps to officially enroll, just as he or she must pick a plan after the application is processed?
The federal health department said they shouldn’t have to. Instead, "the state Medicaid or CHIP agency takes additional steps to finalize an eligibility determination," according to a health department report.
In states like Kentucky, who run their own marketplace, it’s pretty seamless.
"We have a streamlined application process," said Jill Midkiff, spokeswoman for the Kentucky Cabinet of Health and Family Services. "Somebody comes in and gives the information, and if they’re determined eligible for Medicaid then they’re directed to Medicaid, and that happens pretty quickly."
From there, the applicant picks a Medicaid provider, and if they don’t, one is assigned to them.
For states operating under the federal marketplace, the process involves a bit more red tape.
In some states, Medicaid eligibility is determined by the federal marketplaces, and if eligibility is met, the individual should be all set. In others, the final eligibility determination is left up to the states.
Florida, for example, opted out of the Medicaid expansion under Obamacare and chose not to operate its own marketplace. Some people applying through healthcare.gov are eligible for the state’s existing program. For those people, a spokeswoman for the Florida Department of Children and Families said determining final eligibility will be "quick but not automatic."
But there’s a delay in that process. The federal marketplaces do not yet have the functionality to transfer Medicaid eligibility data to the states. And it’s unclear when it will be. With 36 states relying on the federal government to run the insurance marketplace, that could push back Medicaid enrollment for thousands beyond Jan. 1 if it is not fixed in the coming weeks.
As another example, Arizona expanded Medicaid, but also allowed the federal government to run its exchange. There, officials are advising anyone who was told by the federal marketplace they may be eligible for Medicaid to just apply through the state’s online Medicaid portal.
"Once all of these systems are running as they should, there will be no wrong door," said Monica Coury with the Arizona Health Care Cost Containment Systems. "The account transfer of Medicaid eligible from the Marketplace to the state will be seamless. But for now, it’s not working as it should, and anyone that looks Medicaid-eligible needs to come in through the state’s site."
A final note: It’s not clear how many individuals told they were eligible for Medicaid would have qualified even before the expansion of the program under Obamacare. Those numbers have not been released by the administration. So it’s possible a large chunk of new Medicaid enrollees would have qualified for the joint federal-state program prior to passage of the Affordable Care Act.
Wasserman Schultz said "500,000 people have signed up for #Obamacare." The numbers add up if you count different parts of the law that work together to expand coverage, but it’s a little simplistic. The fate of many of the Medicaid enrollees remains up in the air due to the problems with the federal marketplace. It’s unclear whether those individuals will receive their benefits on time, and some are being asked to take additional steps to sign up. Her statement is partially accurate but leaves out important details. We rate her statement Half True.
Rep. Debbie Wasserman Schultz, Twitter post, Nov. 16, 2013
Email interview with Jonathan Beeton, spokesman for Rep. Debbie Wasserman Schultz, Nov. 19, 2013
President Barack Obama, Wall Street Journal CEO Council meeting, Nov. 19, 2013
U.S. Department of Health and Human Services, "106,185 Americans selected health plans in first reporting period of open enrollment," Nov. 13, 2013
U.S. Department of Health and Human Services, "Health Insurance Marketplace: November Enrollment Report," Nov. 13, 2013
Email interview with Emma Sandoe, spokeswoman for U.S. Department of Health and Human Services, Nov. 19-20, 2013
Interview with Jill Midkiff, spokeswoman for the Kentucky Cabinet of Health and Family Services, Nov. 20, 2013
Email interview with Alexis A. Lambert, spokeswoman for the Florida Department of Children and Families, Nov. 20, 2013
Email interview with Monica Coury, assistant director for the Arizona Health Care Cost Containment Systems Office of Intergovernmental Relations, Nov. 20, 2013
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