The number seemed tiny, even for the nation’s least populated state.
Only 85 Wyoming residents enrolled in health plans via the federal insurance marketplace in its first month of existence. Technical problems with the marketplace website, healthcare.gov, made it practically impossible to shop for insurance, or even register for an account.
The paltry enrollment figure was even more disappointing considering 89,000 Wyomingites, or about 15 percent of the state’s population, lack any form of coverage.
For critics of the new exchange and the Affordable Care Act that spawned it, the sluggish start gave credence to long-held concerns the new system was just too big and complicated to succeed.
Then things started to change. Enrollment grew from 85 at the end of October to 521 a month later. Demand further spiked in December, with both WINhealth and Blue Cross Blue Shield of Wyoming – the two Wyoming companies selling through the exchange – each enrolling more than 50 people a day.
The slow start and subsequent surge illustrate the difficulty in making accurate predictions about the exchange, a virtual marketplace where consumers can shop for coverage. Executives at both insurance companies say it’s too soon to know whether it will ultimately be successful.
This year could offer some clues. Consumers will begin responding to changes brought by the health care reform law, said Blue Cross Blue Shield President Rick Schum. No one knows yet whether people will be satisfied with new insurance plans or how many small businesses will drop coverage for their employees.
“We are going to see how this great experiment will be adopted by the consumers,” he said.
It’s unrealistic to think consumers will accept all of the changes, considering the scope, Schum said. Health care accounts for more than a sixth of U.S. spending. Given that, some pushback from consumers is inevitable. The pushback will prompt changes. It’s just too soon to say what they’ll look like.
“To say this is going to work smoothly is probably Pollyannaish,” he said.
Wyoming officials gave serious thought three years ago to starting their own health exchange before ultimately deciding to leave the matter to the federal government. During that process, they commissioned studies to consider how a state-run exchange might perform.
The studies estimated between 24,000 and 41,000 people would use the exchange to purchase health coverage.
Schum said he can’t predict whether the federal exchange will actually make a dent in Wyoming’s uninsured population. So many factors are involved. For example, even if more people find coverage, a sour economy could negate the gains.
“I think it will be a while before we know whether the needle is moving in one direction or another,” he said. “It moves all the time.”
Besides helping consumers shop for insurance, the marketplace is designed as a vehicle for income-based federal subsidies. In some cases, the subsidies can lower consumer premiums by hundreds of dollars each month.
The subsidies could help many Wyomingites who now go without insurance, said WINhealth President Stephen Goldstone. That in turn could reduce the cost shifting that occurs when hospitals treat the uninsured and then attempt to recover lost revenue through higher prices for those who can pay.
“Doesn’t it make sense to get them some coverage, which over the long-term, should help us all?” he asked.
Goldstone doesn’t expect the exchange will solve all of the state’s health care problems. But he also believes people should wait before pronouncing its fate.
Critics were quick to write off the exchange during its troubled launch. Back then, Goldstone predicted enrollments would grow over the remainder of 2013. They did.
“It’s never going to be as good as the most ardent supporters say it will be,” he said. “And it will never be as bad as the most ardent detractors said it would be. It will be somewhere in between.”