Comparing State-based, Federal Marketplace Enrollment

April 7, 2014
Laura Joszt

State-based health insurance marketplaces have been more successful in reaching projected enrollment levels than the federally facilitated marketplaces, with some states already surpassing projected figures.

State-based health insurance marketplaces have been more successful in reaching projected enrollment levels than the federally facilitated marketplaces, according a report from Robert Wood Johnson Foundation (RWJF) and the Urban Institute.

The report was created using data as of March 1, when enrollment numbers from the Department of Health and Human Services showed that 4.2 million people had chosen marketplace-based plans.

By March 1, state-based marketplaces had enrolled 76% of the enrollment projected for the entire year, while federally facilitated marketplaces had only enrolled 54% of the total projected for the entire year. Enrollment numbers represented 24% of projected enrollment by 2016.

The 17 states with their own marketplaces enrolled 1.7 million people, while the federally run marketplaces in the remainder of the country enrolled 2.6 million.

Vermont, Connecticut, and the District of Columbia—all with their own state-based marketplaces—have already exceeded projected 2014 enrollment figures, according to the report. Rhode Island and California are both close at 98% and 96%, respectively.

In contrast, just 4 of the 34 federally facilitated marketplace states had enrolled more than 70% (North Carolina, Michigan, Florida, and Maine) while 20 of these states reported enrollment rates below 50%.

According to the report from RWJF and the Urban Institute, marketplaces had reached only 13% of their target population—pre-reform nongroup insurance enrollees and uninsured individuals ineligible for public insurance or affordable employer-based covered—by March 1.

Some states and the federal government expanded enrollment periods for those who reported difficulties using the online enrollment system, specifically Healthcare.gov. Also, those experiencing a qualifying event such as birth of a child, divorce, significant change in income, etc., will be allowed a special open-enrollment period. Throughout the year enrollment numbers for the health insurance marketplaces will likely continue to increase.

Meanwhile, the Health Reform Monitoring Survey, partially funded by RWJF and conducted by the Urban Institute, revealed that the percentage of uninsured Americans fell from 17.9% in September 2013 to 15.2% at the beginning of March.

“The 15 percent drop in uninsurance among adults since September reveals a very promising start for the ACA’s key coverage expansion provisions,” said Sharon Long, an Urban Institute health economist and the coordinator of its Health Reform Monitoring Survey. “One can expect even more significant changes as the end-of-March surge in enrollments is accounted for.”

Since 80% of the survey was completed by March 6, the uninsured rate does not reflect the enrollment surge from late in March.