Report: PPACA Enrollment Success Depends on More Than Exchange Structure

Although the state-based health insurance exchanges have had higher enrollment rates on average, the federal marketplace gained considerable ground during the last few weeks of the 2014 open enrollment period, according to a report released by the Robert Wood Johnson Foundation.

Researchers from the University of Pennsylvania's Leonard Davis Institute in Philadelphia analyzed Patient Protection and Affordable Care Act exchange enrollment data from HHS. There was significant variation among the states and within the different types of exchanges. The researchers found enrollment rates of potentially eligible people within the federally facilitated marketplaces ranged from 11 percent in South Dakota to 39 percent in Florida. In the state-based exchanges, rates ranged from 12 percent in Massachusetts to 85 percent in Vermont.   

 However, on average, the 16 state-based exchanges enrolled 32.5 percent of potentially eligible enrollees, compared with 26.3 percent for the 27 states that relied on the federal exchange and 26 percent for the seven state-federal partnership exchanges. Overall, more than 8 million people signed up for health plans through the PPACA exchanges. "Given their traditional role in regulating insurance, it is not surprising that state-based marketplaces had the greatest initial success," the researchers wrote.

However, during the final four to six weeks of open enrollment for 2014, the federally facilitated state marketplaces saw enrollment rise by 111 percent, while the state-based and partnership exchanges saw enrollment increase by 60 percent and 89 percent, respectively, according to the report. Study co-author Janet Weiner, associate director for health policy at the Davis Institute, says the increase in enrollment in the federally run marketplaces was likely the result of advocacy efforts by groups such as Enroll America.

"Florida had quite a surge," she says. "When I looked to see what had happened in Florida, they had [HHS Secretary] Kathleen Sebelius there, and they had a big marketing effort by the federal government."

Overall, the researchers concluded their findings suggest the exchanges' structural differences may not matter as much to enrollment success as other aspects such as marketing and outreach programs.

"We're starting to believe that some of the differences in whether a state had decided to run its own exchange…may not be as important in the long run as the more process-oriented aspects: Do you have people on the ground? Are you doing the consumer assistance in marketing?" Ms. Weiner says. "That was my biggest takeaway in this."

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