Back in August when Obama administration officials were giving reporters briefings about how amazing healthcare.gov was going to be (they were really excited about it) they set a target for 7 million sign-ups through March 2014 of which they wanted about 2.7 million—40 percent—to be below the age of 35.
Now the numbers are out, and through December they have 2.2 million sign-ups of which 30 percent are under the age of 35.
In other words, not enough. The “don’t panic” news is that this is not an unexpected pattern. December isn’t March, and the experience of Massachusetts was that younger people were disproportionately likely to sign up late. If you use Commonwealth Care as a baseline, the exchanges are ahead of pace:
But here’s the problem. The federal Health Insurance Marketplace isn’t a single insurance risk pool. Because insurance is regulated at the state level, even the “federal” exchange is essentially an administrative mechanism for a couple of dozen separate risk pools. Each state needs a demographically balanced set of clients, it’s not good enough to just be balanced on average. And even though the variance between the different states isn’t huge, it’s not nothing either. The odds that at least one or two states will fall short are much higher than the odds that the federal exchange on the whole will fall short. Now in a sense, a program that works in 48 states is doing a lot of good even if for some reason it doesn’t come together right in North Dakota and Maine (or wherever). But it would be a huge embarrassment for a program that’s already witnessed a lot of embarrassing failures.
The reality here is you shouldn’t buy into the fevered excitement of the people who are simultaneously hoping this will fail and are certain that it will. But the people working on this in Washington and in the states are sweating the numbers a bit, and rightly so. There’s a reason they wanted the marketplaces to open in the fall rather than in December and there’s a reason they thought a working website would be an important element of rolling this thing out.