HHS announces "effectuated" enrollment in ACA plans

March Effectuated Enrollment Consistent with Department’s 2015 Goal, June 2, 2015

The Centers for Medicare & Medicaid Services today released a data snapshot providing a detailed look at how many consumers paid their premiums in 2015 and had “effectuated” coverage in March 2015. During Open Enrollment for 2015 Marketplace coverage, through February 22, about 11.7 million Americans selected plans through the Marketplaces. On March 31, 2015, about 10.2 million consumers had “effectuated” coverage which means those individuals paid for Marketplace coverage and still have an active policy on that date.

Nearly 8.7 million (85 percent) consumers nationwide and 6.4 million consumers in the 34 states with Federally-facilitated Marketplaces received an average premium tax credit of $272 per month to make their premiums more affordable throughout the year.

In November 2014, the Department set a goal of 9.1 million effectuated enrollees at the end of calendar year 2015.  The March 2015 effectuated enrollment number is consistent with meeting the Department’s goal for 2015 effectuated enrollment.

The Marketplace effectuated enrollment snapshot provides point-in-time estimates of individuals who effectuated their enrollment and have an active policy on that date; it does not measure the rate at which consumers pay their first month’s premium. As is the case in other well-functioning insurance markets, CMS expects these numbers to change over time in response to changes in consumer needs and life circumstances such as employment status or marriage, which may cause consumers to newly enroll in, change, or cancel their plans.

March 31, 2015 Effectuated Enrollment:



By Don McCanne, MD

“Effectuated” enrollment in the ACA exchange plans is an evasive term to obscure the fact that 13 percent of those enrolled for 2015 had already dropped out by the end of the first quarter. Also, when they decided that previous anticipated levels of enrollment were unrealistic, they set a lower goal which they now report that were able to meet. Surprise!

They do concede that exchange plan enrollment is inherently unstable, as with “other well-functioning insurance markets,” they state. Not only do large numbers of eligible individuals fail to attempt to enroll, but changing circumstances and eligibility cause attrition in enrollment, especially for those who find that they are unable to pay their share of the premium.

If we really want everyone insured, this clearly is not the way to do it. “Well functioning insurance markets” that leave tens of millions uninsured is not a standard that we should accept. Enrollment should be automatic for everyone, for life. Single payer is what we need.