Report: State-Based Marketplaces More Successful Than HealthCare.gov

Through March 1, the state-based health insurance marketplaces were generally more successful in achieving enrollment projections than the federally facilitated marketplaces, according to a report from the Robert Wood Johnson Foundation and the Urban Institute.

As of March 1, HHS reported more than 4.2 million people had selected health plans through the PPACA marketplaces (as of April 1, that number had risen to 7.1 million). Researchers compared that enrollment data on a state-specific level with  projected enrollment for 2014 and 2016 based on survey data. They found that, overall, state-based marketplaces had achieved 76 percent of projected 2014 enrollment by March 1, compared with 54 percent for the federally facilitated marketplaces.

Three of the 17 state-based marketplaces — Vermont, Connecticut and the District of Columbia — had already exceeded their projected 2014 enrollment. Meanwhile, none of the 34 states with federally facilitated marketplaces had reached enrollment projections by March 1, according to the report.

Report co-author and Urban Institute fellow John Holahan, PhD, says that for the most part, the states that opted to run their own exchanges developed their systems earlier and faced little opposition to the marketplaces, and they received a boost from federal funds made available for outreach efforts and website construction. "There wasn't a hostile reaction to the [PPACA] in most of these states," Dr. Holahan says.

Still, not all state-based exchanges have fared well. For instance, Maryland recently decided to revamp its health insurance exchange, which crashed soon after it launched last fall and has performed poorly since: As of last Friday, only 49,293 people had enrolled in private health plans through the exchange, far short of the 150,000 people Maryland had hoped to sign up. The exchanges in Oregon, Hawaii and Massachusetts have also floundered.

Within the state-based marketplace and federally facilitated marketplace categories, enrollment varied significantly, according to the report. In the state-based marketplaces, progress ranged from 14.8 percent of projected 2014 enrollment in Massachusetts to 178.9 percent in Vermont. Meanwhile, in states that relied on the federal facilitation, actual enrollment as a share of 2014 projections ranged from 26.2 percent in North Dakota to 81.5 percent in North Carolina.

Regardless of their marketplace type, the report concludes all states will likely see "substantial" enrollment increases in the coming years as people become more familiar with the exchanges, more outreach efforts are conducted and exchange glitches from the first year get fixed.

Dr. Holahan also says healthcare providers and others in the industry will likely play a part in boosting enrollment. "Hospitals, insurers and other people will have big outreach campaigns now that the system is working," he says.

More Articles on PPACA Enrollment:
Exceeding Expectations: How the PPACA Exchanges Broke 7M  
Obama Announces April 15 Cutoff for PPACA Enrollment Extension  
Maryland to Rebuild Health Insurance Exchange Website 

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