Obamacare enrollment: The best and worst states by the numbers

Enrollment in Obamacare plans quadrupled since October, but where is health reform really taking off?

Life & Health


Nearly 365,000 Americans have selected a health plan through the state and federal Affordable Care Act exchanges, the Obama administration announced this week. The White House noted with pride that more than four times the number of individuals signed up for healthcare in November than October—a sign of a better-performing HealthCare.gov.

However, Insurance Business can reveal that the rush to sign up for Obamacare plans wasn’t exactly an equal opportunity experience across the US last month.

In fact, the five states that saw the most enrollments per capita didn’t use the federal exchange at all. Vermont, Connecticut, Kentucky, California and Washington all operate their own state-based exchanges—a move California Association of Health Underwriters President Sam Smith said had a lot to do with the positive returns.

“Every state is unique in its character and content of the population, especially California,” Smith said. “We have such a diverse population that if we were to be a round peg crammed into the square hole of the federal exchange, it just wouldn’t have worked as well.”

Smith explained that the state’s exchange, Covered California, operates in 13 different languages and that officials easily performed outreaches to unique communities that may not have otherwise thought of applying for insurance through the marketplace.

“It’s because it’s a California-based exchange,” Smith said. “We know the people. We know the communities that needed outreach.”

Smith added that preparing for the Oct. 1 rollout nearly two years before the HHS started work on HealthCare.gov also had a lot to do with California’s success, though he admitted Covered California still had a few kinks to work out.

On the opposite end of the spectrum, Hawaii, Mississippi, Iowa, Massachusetts and Oregon have experienced abysmal numbers.

While Hawaii and Oregon wrangle with malfunctioning state-based exchanges—and Massachusetts already experiences a high number of insured residents due to earlier healthcare reform—Mississippi saw just 802 of its 2.9mn residents sign up through HealthCare.gov. In Iowa, just 757 people managed to enroll in an Obamacare plan.

Smith said some of the problem in states like Mississippi and Iowa is a complete refusal to participate in healthcare reform.

“The states that adopted their own exchanges tended to be states supportive of the ACA,” he said. “It’s been a double-edged sword, I think, on the others. Here, we welcomed the exchange and the ACA. We’ve embraced healthcare reform from the beginning. It makes a big difference in enrollment.”


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