Buried in a largely overlooked government audit of the Obama-Care exchanges is a finding that casts still more doubt on the reliability of the 8 million enrollment number commonly cited by the administration and the press.
In a section titled "Other Issues," an inspector general report released last week found that the HealthCare.gov marketplace couldn't show it had been reconciling its monthly enrollment numbers with insurance companies.
That's despite the fact that the law specifically calls for this reconciliation, and the fact that, as the IG report notes, "the federal marketplace obtained the services of a contractor to reconcile enrollment information.
Obama administration officials "stated that the system to support reconciliations had yet to be developed.
But as the IG makes clear, without this monthly reconciliation, the government "cannot effectively monitor the current enrollment status of applicants, such as ... termination of plans.
Perhaps Far Fewer Enrollees
In other words, there could be far fewer enrollees than advertised if these numbers were reconciled as required by law. The administration told the IG that it had "an interim process" in place until its automated reporting system was up and running.
The report didn't say whether this same reconciliation problem exists at the 14 state-run exchanges.
That finding comes on top of other known problems with the ObamaCare enrollment numbers, not the least of which is that they include anyone who selected a plan, not only those who have actually paid their premiums.
The administration hasn't released updated enrollment numbers since May, which covered the entire open enrollment period at the federal exchange. An update would shed light on how many are keeping up with premium payments.
But 15 states have separately reported paid enrollment numbers, and according to data compiled by ACASignups.net, paid enrollment is 322,000 fewer than the last official White House count — which means nearly 13% of those counted haven't paid their premiums.
That website estimates that if the payment rate in the remaining states averaged 90%, actual enrollment would be less than 7.2 million, not the 8 million touted by the administration.
Aetna says that out of 720,000 sign-ups, only about 580,000 were paid up by May 20, a payment rate of only 80.6%.
It's also unknown how many have failed to keep up with their payments after making the initial one — the law gives consumers a three-month grace period before insurers can cancel their coverage. But the number could be significant.
A Kaiser Family Foundation survey found that 43% of those buying ObamaCare plans say they are having difficulty paying premiums, with 14% finding it "very difficult.
That's despite the fact that 87% of those who bought one of these plans through HealthCare.gov got taxpayer subsidies.
85% Pay, Then Fewer Monthly
Widely followed industry analyst Robert Laszewski of Health Policy and Strategy Associates, said that "generally, carriers are saying that 85% paid the first month and that enrollment deteriorates after that at a rate of 2% to 3% per month.
If those estimates turn out to be true, the administration's 8 million would fall to around 6.1 million after six months — or right about where the Congressional Budget Office predicted enrollment would be in ObamaCare's first year.
The administration says it has no current plans to provide updated enrollment numbers that would reflect people who've dropped coverage or had it canceled, along with those who signed up after open enrollment.
However, it may be possible to get some sense of all this when insurance companies start releasing their Q2 earnings reports later this month.
2.9 Million Inconsistencies
An additional problem with the official enrollment numbers turned up in a separate IG report, which found 2.9 million "inconsistencies" between what applicants said and what government data show about income, citizenship and the like in the first five months of open enrollment.
Of those, 2.6 million couldn't be resolved, the IG said. And 1.65 million of these involved potential eligibility problems, either inconsistencies regarding citizenship or legal status, or whether the applicants already had "affordable" coverage at work, which would make them ineligible to sign up for a subsidized ObamaCare plan.
If only a small portion of these 1.65 million are, in fact, ineligible, that would translate into another significant cut in actual ObamaCare enrollment.