Obamacare enrollment: The best and worst states by the numbers

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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.”

  • Ray on 12/13/2013 9:33:49 AM

    It's a shame so many "conservative states" punted their decision to the federal government instead of doing it themselves. Why would they want to make the federal government bigger? more involved? That is not the conservative way and some will be called out on it if the media figures it out.

  • James Kenyon on 12/13/2013 10:43:22 AM

    Ray, you are being too practical. Of course states could perform better than HHS. Unfortunately the political overtones fail to allow the best course of action to prevail. I've heard it said too many times that the Right is waiting for ObamaCare to fail so the opportinty to fix it and say "I told you so." will present itself.

  • Caren on 12/13/2013 11:11:38 AM

    I agree that conservatives have tried to create an environment for failure. I've been making follow up calls on currently uninsured people. I"ve have been told twice now that they are going to wait as they heard on the (conservative station) news, it was extended another year before they would need to sign up. The way the news story was presented, they understood the small business mandate extension also meant individuals had an additional year. I'm in a state that didn't expand Medicaid so the really low income people are still stuck without insurance or have to pay for it in full with no subsidy. Yes, they can be exempted but that doesn't help them if they want and need insurance.

  • David on 12/13/2013 3:49:29 PM

    In our state, somewhere over 3000 have signed up as of Dec 9th. The overwhelming majority have been directed to Medicaid. My concern is what impact that will have on an almost bankrupt system in our state.

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