WASHINGTON - After anemic enrollment in the new health insurance marketplaces in October, states have begun to see a much faster pace of sign-ups in November, prompting health policy researchers to announce a "November surge."
By the end of October, the federal government had counted 106,000 people enrolled into private coverage through the 14 new state-based marketplaces and the federal marketplace, a small percentage of the projected half-million sign-ups.
By mid-November, though, with the state marketplaces reporting fresh data, that number had just about doubled to more than 200,000.
"The latest enrollment figures from the 14 states that are running their own marketplaces show that enrollment has climbed to at least 200,000 people nationwide," Sara Collins and Tracy Garber wrote Friday for the Commonwealth Fund. "This latest figure does not account for any new enrollment in the federal marketplaces in 36 states, which is also likely to have increased since early November."
News of the surge comes as the Department of Health and Human Services (HHS) announced it is giving people an extra week in December to sign up for coverage that begins right at the start of the new year. The previous Dec. 15 deadline is going to get pushed back to Dec. 23, spokeswoman Julie Bataille said Friday. This will only be true in December; in all other months of open enrollment after Jan. 1, the deadline for buying coverage the next month will be the 15th of the month prior.
Republicans cried foul over another on-the-fly delay in the rollout of the plan. HHS also said that it is changing the 2015 open-enrollment period for the new federal healthcare exchanges, according to an HHS official. While the 2015 enrollment period had been set to begin Oct. 15, 2014, and end Dec. 7, it will now begin Nov. 15, 2014, and end Jan. 15, 2015.
Republicans accused the administration of a blatantly political effort to push the enrollment period until after the 2014 election, which will be held Nov. 4, and delay bad news that might result from the next round of open enrollment.
"Clearly, President Obama does not want voters to see increased prices, more cancellations and decreased options under 'Obamacare' before they go to the ballot box," House Majority Leader Eric Cantor, R-Va., said in a statement. "If 'Obamacare' is so great, why are Democrats so scared of voters knowing its consequences?"
Also on Friday, Jeff Zients, who was appointed by President Barack Obama to fix Healthcare.gov's problems, said he was "very confident" that the site would be able to handle 50,000 concurrent users by the end of this month. "The site was originally intended to handle this load and improvements will bring it up to this level," Zients said. "We will have the capacity that was intended."
HHS will also be implementing what they describe as a "queuing system," to deal with moments when there are too many users on the website. In those cases, users will have the opportunity to receive an email from HealthCare.gov notifying them when the site is having lower traffic and would work better.
However, the website will down for maintenance again from Saturday night to Sunday morning.
Despite weeks of bad headlines for the law and an increasing number of Americans opposing it, the vast majority of Americans still do not expect it to have a negative impact on them personally, according to a new Kaiser Family Foundation poll. The survey found that 32 percent of people say they expect to be worse off under the measure. That number is basically unchanged from the past few years and exactly the same as it was right after the bill was signed into law in 2010.
The number expecting to be better off has declined over the years but didn't dip much in recent weeks. It went from 24 percent in September, before the health exchanges were launched, to 21 percent.
One encouraging sign of supporters: Among the uninsured, the visibility of the exchanges has increased. Nearly 30 percent of them have heard "a lot" or "some" about the marketplaces in November, double the 15 percent who were aware in September.
"It's not all doom and gloom," Kaiser Family Foundation President Drew Altman said of the November uptick in enrollments. "What this says is that the problems are system problems, not problems with demand or interest. Reason would suggest that other states can do as well over time, if we're able to do this in Kentucky or Washington."
California, which has had about 80,000 sign-ups, is reporting about 2,000 enrollments per day. New York and Washington reported double-digit enrollment numbers as of this week.
Health policy experts have always expected that enrollment would be slower in October than it would be in November or December, given that no coverage starts until January.
What they did not expect was a host of technical issues that would make it difficult for even the most eager of shoppers to purchase coverage. The White House contends that this depressed enrollment in October, at least in the federal marketplace.
That hasn't been true everywhere: Some state-based marketplaces had a pretty smooth launch and are seeing the pace of enrollment speed up daily.
California has led the bunch; the state's enrollments have grown steadily in November and account for nearly a full third of all sign-ups.
The state has had its strongest two weeks of enrollment this month.
"We're seeing much larger numbers than we expected," Covered California Executive Director Peter Lee told reporters this week.
Connecticut officials say they have seen about 14 percent of their expected enrollees sign up through mid-November. The state has had about 14,000 people sign up for coverage so far, about 58 percent of whom have purchased private coverage and 42 percent of whom have enrolled in the public Medicaid program.
And in Washington state, enrollment has nearly doubled, from 55,000 at the end of October to 98,000 through Nov. 14.
"We're definitely seeing interest continuing to build," said Michael Marchand, a Washington state exchange spokesman. "I fully suspect we may have half our enrollment coming in December. Especially for those who are buying private plans where payment isn't due until December, some of them are sitting back and waiting to take action."
Other states are expecting a similar, post-Thanksgiving wave.
"We're going to see a surge, after Thanksgiving and mid-December, and I think that mix is going to favor more folks" picking private plans than Medicaid, said Kevin Counihan, executive director of Connecticut's Access Health CT.
A handful of functional state marketplaces don't fix all the problems that states are having with the federal marketplace. Instead, Kaiser Family Foundation's Altman sees the snowballing enrollment numbers as a proof of concept.
"We're in a period of a terrible rollout," Altman said, "but the performance of the pace-setting states should be a cause of optimism for supporters."
The news is not as good for the federal health insurance website. Brokers and agents say technological problems are blocking their ability to help consumers sign up for coverage through the site.
They say it is a particular problem for people with major health issues because they are least able to weather a gap in coverage.