A late surge of sign-ups pushed California's health insurance exchange nearly 100,000 enrollees beyond the original projections of the Obama administration, state officials announced Thursday.
Nearly 1.4 million Californians selected a private policy through the state's exchange by Tuesday's open enrollment extension, and 88 percent were eligible for subsidies to reduce their monthly premiums.
"That is a huge number," said Covered California Executive Director Peter Lee, announcing the enrollment numbers. "We're proud that those Californians are part of history, part of a new era where Californians and Americans have health care as a right and not a privilege."
Among the questions going forward are whether the newly purchased insurance policies will meet consumers' expectations and whether the mix of enrollees will be sufficient to satisfy insurance companies that are participating in the exchange.
Insurers said they needed strong sign-ups from younger and healthier people to balance out the older and sicker consumers who sign up under the Affordable Care Act. Older people generally need more health care services and are more costly to insure.
Insurance industry experts say about 40 percent of enrollees should be between 18- and 34-years-old to ensure plans balance financially. The data released by Covered California show that 29 percent of individual enrollees were in that demographic. That demographic is about 25 percent of California's total population.
Covered California extended open enrollment for two weeks beyond the original March 31 deadline because its computer system and call centers could not handle the crush of people rushing to sign up for health coverage at the last minute.
During that two-week extension, more than 205,000 Californians signed up for coverage, Lee said.
Overall, the Obama administration had projected California would enroll 1.3 million during the first enrollment period, which began Oct. 1. Covered California said the state had set a target of around 830,000.
The state also accepted the expansion of the low-income health insurance program that was offered under the federal health care law.
Toby Douglas, director of the California Department of Health Care Services, said more work should be done to make Medi-Cal, California's version of Medicaid, more user-friendly and efficient. While roughly 1.9 million people gained coverage through Medi-Cal as a result of the federal overhaul, about 800,000 people are still waiting for their applications to be processed.
It's not yet known how many of the 3.3 million Californians who enrolled in private health plans or Medi-Cal did not have insurance previously. Lee said a better picture will come with future surveys. Lowering the number of uninsured across the country was one of the chief goals of the Affordable Care Act.
One concern in California and other states running their own health insurance exchanges is whether sign-ups would be robust enough for the agencies to be financially self-sufficient starting next year, as the federal law requires.
Lee said the Covered California board would be receiving a preliminary budget for next year and expressed optimism that the agency will be able to cover its operating expenses.
"We are very comfortable that this high enrollment assures what was always assured, which is that as we move from being supported with federal funding to being supported with an assessment on premiums, we're going to be in very good shape," he said.
Other details from individual insurance enrollment data released Thursday:
- 85 percent are anticipated to pay monthly premiums.
- Latinos accounted for 28 percent of marketplace enrollment and 38 percent of Medi-Cal sign-ups. Latinos make up 39 percent of California's population.
- Whites made up 35 percent of enrollees, Asians 21 percent, blacks nearly 3 percent and those identifying as mixed race about 6 percent.
- About 62 percent of enrollees selected a mid-tier Silver plan, which is the one used to calculate subsidies, while about 26 percent selected the cheapest plan; 11 percent selected either a Gold or Platinum plan, which come with higher premiums but lower deductibles and other out-of-pocket expenses.
- 94 percent of consumers enrolled with the four large insurers offering coverage on the exchange: Anthem Blue Cross of California; Blue Shield of California; Health Net; and Kaiser Permanente. Seven smaller nonprofit insurers divided the rest.