Health Care Marketplaces Expand, but Answers for Shoppers Remain Scarce

Last week, the Department of Health and Human Services announced that the number of insurers participating in state marketplaces was on the rise. But it didn't say whether that improved competition was taking place everywhere, or just in the urban markets that already had a lot of insurance carriers.

The week before, it announced that 7.3 million Americans were currently enrolled in marketplace plans created by the Affordable Care Act. But it didn't share a breakdown by health plan, state, age or income.

These recent data releases from the department paint an upbeat picture of the act's progress so far. But the lack of detail makes it difficult to know whether its programs are working well for all the groups they were designed to serve. This is not to say that the department is hiding anything; in both cases, the department simply doesn't have many of those details - a disquieting thought less than two months before open enrollment begins for 2015.

Take the insurance carriers. The increase in competition in many states is a sign that the exchanges are working as intended - by creating regulated marketplaces where insurers compete on price to woo customers. More insurers tend to be associated with lower prices and more consumer choice, goals of the law.

But in most states, insurance isn't sold statewide. Instead, insurers sell to customers in local markets.

This year, most large metropolitan areas in the United States already had robust competitive marketplaces, but many rural areas did not. A New York Times analysis found a majority of counties served by the federal exchange in 2014 had fewer than three competitors - and higher premiums than nearby places with more competition.

The data from the administration do not indicate whether that divergence has been reversed. It's possible that competition is improving everywhere in the country - or that things got better in urban markets, while rural customers continue to face high prices and few choices.

'At this point we don't have issuer data beyond the state level that would produce reliable metrics,' said Ben Wakana, a spokesman for the department, in an email. Mr. Wakana said the department was committed to transparency. 'We will continue to provide additional information in the months to come,' he wrote.

The new marketplaces will go live on Nov. 15.

The department also recently released an updated total number of people who are enrolled in marketplace plans: 7.3 million. That's the only current data about enrollments that it has released. During the open enrollment period earlier this year, it published monthly totals of initial sign-ups, along with breakdowns by state, age and income level. Toward the end of the enrollment period, it released information about the types of plans that people chose.

The recent number ends several months of silence about enrollment in exchange plans. But it doesn't include any of that detail. It also doesn't tell us how many of the people currently enrolled are those who signed up initially, and how many have cycled in and out of coverage.

The department hasn't reported the detailed numbers because it doesn't know them. The back-end computer systems used to communicate with health insurance plans still aren't complete, meaning that the department can't get detailed data about individual plans.

The initial estimates were based on people's plan selection on the website, while the new number captures those people who are actively enrolled in plans and paying premiums. But without reliable sharing of data between the Department of Health and Human Services and insurers, there's no easy way for the department - or the public - to describe those enrollees. 'We're actively working on it,' said Aaron Albright, a spokesman for the Centers for Medicare and Medicaid Services, which manages Healthcare.gov.

The good news about the health law's marketplaces is still - over all - good. Increased competition and a stable number of people enrolled in marketplace plans are both positive signs that suggest the policy is working as intended in many places. Initial data about premiums for 2015 in the states that have published them also seem promising. But the currently available data could be disguising real regional variations.

The lack of data also raises questions about how smoothly the mechanics of Healthcare.gov will function once the open enrollment period begins. The website will need to list all the plans in each market so consumers can shop. The department is planning to renew millions of existing customers into their current plans. Those processes will need to be ready in just a few weeks.