The Post Has Problems With Its Scorecard in Assessing State Enrollment in the ACA

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Sunday, 29 June 2014 15:32

The Washington Post did an assessment of which states had the largest share of their eligible population enroll in the exchanges and which states were least successful. California topped the charts with 42 percent of the eligible population followed by Vermont. Picking up the rear was Hawaii, where it tells us less than 15 percent of the eligible population enrolled.

There is a big problem with the Post's scorecard. The states didn't start in the same place. In last place Hawaii only 8 percent of its population was uninsured. By contrast, in California 19 percent of its population was uninsured. This means that even with the differences in ACA enrollment Hawaii likely still have a higher insurance rate than California.

While the piece notes Hawaii's problems in setting up its exchange, it is also the case that as the share of the population who is uninsured gets lower, it becomes more difficult to enroll the people who remain uninsured. These people are likely resistant to signing up for insurance or have difficulties navigating bureaucracies. Therefore it should not be surprising that Hawaii did not do well on this measure.

The piece also highlights enrollments of people 18-32. While there had been much hype around enrolling "young invincibles," as Kaiser has shown the difference in premiums largely reflects the differences in health care costs. It really doesn't matter much for the finances of the program how many young people enroll, although it is good to see them getting insurance.