Now that open enrollment is closed and the dust is starting to settle, we’re getting some idea of who signed up for the federal and state health exchanges, information that should allow us to start separating fact from fiction.

Fact: 8,019,763 people selected Marketplace plans from October 1, 2013 through April 19, 2014.

Fiction:  That does not mean 8,019,763 people signed up or purchased health insurance on the exchanges.  This number represents the number of people who selected plans.  It is anticipated that the number of people who will actually pay their first month’s premium and activate their health insurance policies will be anywhere between 15 and 40 percent less than those who selected Marketplace plans.

Fact:  Not enough young, healthy people signed up for health insurance on the exchanges to make the exchanges financially viable for carriers.  The exchanges needed 41 percent of the enrollees to be between 18 and 34.  Only 28 percent of those signing up were in this age bracket, meaning some carriers will lose money on the exchanges once claims start accumulating because there are more older and sick enrollees than young and healthy enrollees.

Fiction:  The government will bail out insurance carriers who lose money by funding their losses.  The federal government will not bail out carriers who lose money due to excessive claims on their ObamaCare ACA (Affordable Care Act) plans.  However, there is a Risk Adjustment Pool (created with ACA monies and taxes) to reimburse carriers who have greater losses than those projected by HHS (Health and Human Services).  These are not government bailouts since the monies were already set aside in the ACA tax and fee structure.  Additional funding for carriers experiencing disproportionate losses will come from the Risk Corridor and Reinsurance programs, both of which are funded by taxes and fees paid by the carriers and which expire in two years.

Fact: Health insurance on the exchanges costs more than prior individual and family health insurance policies due to new regulations and plan requirements like domestic abuse counselling, mandatory maternity coverage, children on parents’ plans until age 26 and mandatory coverage for contraceptives and abortifacients.

Fiction:  People signed up for health insurance on the exchanges because it cost less money and they were better policies.  Actually 85 percent of the people signing up for ObamacCae received government subsidies to purchase their plans according to CMS (Centers for Medicaid and Medicare Services).

Cary Hall

America’s Healthcare Advocate