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.

Finding coverage

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.”

Contact Joshua Wolfson at 307-266-0582 or at josh.wolfson@trib.com. Visit http://trib.com/news/opinion/blogs/wolfjammies to read his blog. Follow him on Twitter @joshwolfson.

(8) comments

thehousemouse

I wont be signing up anytime soon, based on a few things. for 1000.00 a month to cover me though the exchange. ill be putting that money in a bank where i can collect interest on it and if and when i need something done. well be paying cash. if anyone is going to make iunterest off my hard earned cash it will be me.

Morning Joe
Morning Joe

I'm not knocking the idea of saving money, but do you realize that if you deposit $1,000 monthly for a year at the current interest rates that banks offer, you will earn less than $10 for the first year?

Of course, compound interest is your friend. So lets say you don't have any medical expenses for 10 years and you still deposit $1,000 every month..... your $120,000 savings will have earned around $500.

dd ric

With no state exchange,which i'm waiting for, you have 2 choices,Winhealth or BC/BS. Not much of a choice. When will the insurance commissioners open up state lines,and who decided the state-to state isolationism for insurance,anyway? ddric

Wyopoke

Federal law - been that way forever. Same thing with auto insurance. If I move to colorado and I want to stay with Farmers I need to get a new insurance agent and a new Colorado policy. Even something as simple as trying to stay with the same insurance company requires a new policy to be issued by the in state entity of the same company. Hence BC/BS of Wyoming, Colorado, Montana, etc.

Allowing insurance to be sold across state lines by a single entity should, in and of itself bring cost down by eliminating administrative costs related to having a legal entity in each state and allowing competition as well as allowing small populations like Wyoming to be including in a nationwide pool to take advantage of economy of scale.

I'm no expert but it seems to me that the current situation precluding the sale of insurance across state lines runs counter to the philosophy of a true free market.

Morning Joe
Morning Joe

The reason that selling insurance across state lines is so complicated and not practiced is because states regulate their own markets, states themselves make the rules. Insurance companies must make allowances and adjustments in order to comply with a particular state's rules. In addition, insurance companies are in the business of predicting the amount of loss they may encounter in certain areas, and under certain conditions, then they factor in operating costs and profit..... then adjust the premium accordingly.

Now, let's say that some "like states",... for example: Wyoming, Montana, Utah and Idaho got together and came up with a universal set of regulations. And, let's say that insurance companies could average their predictions for loss and profit over the 4-state area... there is nothing to prevent them from selling policies in all 4 of these states.

Will this bring the cost down for everyone in these 4 states? This is not only the tough question here but a good base for discussion. On a smaller scale this has worked for groups.... unions, industries, organizations, clubs, credit unions etc., can and do offer various insurance policies to their members at lower rates than members might pay individually.

Wyopoke

My comment to that is the business rules are different in every state and many enterprises do business across state lines and deal with the varying rules of conduct. We can make this work if confess would just take off the leash.

Wyopoke

By the way dd ric you make a very good and valid point in getting to the core of the problem.

Wyopoke

The ACA should have contained provisions to sell insurance across state lines. This has been a topic of debate in congress since well before Obamacare. A state run exchange only replaces the federal exchange it does not guarantee more choices as it is the insurance companies who decide where to market their wares and whether or not to participate on any of the exchanges at all. Many insurance companies are choosing to forgo participation on both the federal and state exchanges. If we open the exchanges to allow companies to sell across state lines these voids could be filled.

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