The Seattle Times has a good article from Lisa Stiffler about enrollment issues at the Washington Health Benefit Exchange (HBE). I wrote last week that enrollments are well short of the HBE’s goal for this year’s open enrollment, which ends Feb. 15. Stiffler provides more details:

The trouble for the Washington Health Benefit Exchange, which runs the state insurance marketplace, is that too few people are buying their coverage through the Washington Healthplanfinder website, which needs to reach the enrollment targets to help pay for its operating costs. . . .

There are numerous reasons for the underwhelming sales. Some officials think the nationally set enrollment window was badly timed, spanning Thanksgiving and Christmas holidays, when distractions abound and pocketbooks are strained. Then there’s the challenge of enrollment closing before most people fill out their tax returns, which means many uninsured people will realize too late how much they’re being penalized for going without coverage.

In addition, enrollment projections in Washington underestimated how many residents would be eligible for Medicaid, pulling them out of the pool of potential exchange customers. In the past 16 months, the number of Medicaid enrollees has grown by nearly half a million, to 1.7 million.

Finally, many exchange customers from the first enrollment received confusing or insufficient notices about what they needed to do to renew their plans, sometimes leaving them uninsured when they meant for their coverage to continue.

On the point about the timing of open enrollment, Howard Gleckman of the Tax Policy Center compares getting insurance under the Affordable Care Act (ACA) to charitable giving. Gleckman argues that since both these activities are tax-driven, their deadlines should be linked to tax filing season, rather than the end of the calendar year (or thereabouts). This, he thinks, would help maximize participation.

Also, it’s interesting that the HBE underestimated the numbers who would be eligible for Medicaid. There are three sets of people signing up for Medicaid through the Exchange. First are those who were covered by Medicaid before the ACA — they are simply re-enrolling and are funded at the regular federal match (the state pays 50 percent and the feds pay 50 percent). Second are those who are newly eligible for Medicaid as a result of the ACA’s expansion. These are funded 100 percent by the federal government through calendar year 2016, 95 percent in 2017, 94 percent in 2018, 93 percent in 2019, and 90 percent thereafter. Third are those who were previously eligible for Medicaid but had not enrolled; they are funded at the regular match.

The HBE has not released Medicaid enrollment numbers broken down into these categories for this enrollment period. A September report noted that enrollments in Medicaid by those newly eligible under the expansion totaled 352,386; enrollments by those previously eligible totaled 199,631; and renewals totaled 583,765. The apparently unexpectedly high Medicaid numbers are doubly problematic for budget purposes: It means the Exchange gets less business, hurting its budget, and it means that the state must pay more to fund Medicaid (even though there is a high federal match for a portion of those enrollees).

Regarding the HBE budget, Stiffler writes,

. . . funding for Healthplanfinder comes from three sources: the exchange’s share of a 2 percent tax on all insurance premiums, a fee charged on insurance companies selling through the exchange, and from cost sharing with the state agency that manages Medicaid. . . .

The board overseeing the exchange is asking state lawmakers to approve a budget request of $147 million over two years, which is already higher than what the Legislature initially allocated.

Through new sales or renewals, the exchange needs to sell 86,000 plans in the last three weeks of open enrollment to reach its target and provide funding to operate within that request.

Marchand said the exchange knows lawmakers will be looking everywhere to make cuts, not grow budgets.

That could mean paring back services, he said. “We’ve got to figure out how to live within our means.”