A Bleak First Week: 99.6% of Healthcare.gov Visitors Did NOT Enroll in Obamacare


Clarification: The reference to enrollments in this article requires clarification. During Week One, 36,000 consumers completed the eligibility application on Healthcare.gov, rather than fully enrolled in a plan as was originally suggested. Completion of this application is required before consumers are able to compare healthcare options and select a plan. An update on Healthcare.gov’s performance in Week 2 is available here.

Since October 1st, Americans living in the 50 states and Washington, D.C. can purchase healthcare through exchanges as part of the Affordable Care Act (also known as Obamacare.) Little information has been made available by the administration on the level of interest these exchanges have received or more importantly the number of consumers who actually enrolled, although the rollout has been plagued with widespread reports of system outages and bugs.

We prepared the following analysis in order to provide visibility around consumer activity on the various healthcare exchanges since the launch of Obamacare.

Healthcare.gov Enrollment Funnel

Over the course of Obamacare’s first week, 9.5 million people visited healthcare.gov, the federal government’s official healthcare website and the de facto exchange for residents of two thirds of the states. In addition, the 16 operational state-run exchanges combined to attract over 3.1 million visitors during the same period. In total, 11.3 million consumers visited the federal and state exchanges during their first week of operation. Unfortunately, what started as a fire hose of interest, resulted in only a small trickle of actual healthcare enrollments.

Among the visitors to healthcare.gov, 5.7 million (or 60% of total visitors to the site) navigated to the individual marketplace landing page where, after selecting their state, they were either directed to continue using the federal site or were redirected to their state-run exchange. From here 1.3 million left for their state-run exchange, while another 3.7 million attempted to register on healthcare.gov. The latter didn’t get far. For two thirds of these consumers, the site either hung or failed altogether before it was finally taken offline over the first weekend.

Despite a myriad of issues with the site, just over a million consumers actually made it through the first gauntlet and successfully registered on healthcare.gov, after which they were sent verification emails. Problems persisted as consumers next encountered difficulty verifying their email addresses and logging into the accounts they had just created. Over 214,000 consumers sought help on the “I’m having trouble logging in to my marketplace account” page, making it one of the most popular pages on the site. Just 27% of those who registered on healthcare.gov successfully logged into accounts.

For those that could log in, the next step was enrollment. Over 196,000 consumers began the over 30-step enrollment process that first week, although the majority stopped well short of completion. This is likely a reflection both of continued technical issues as well as consumers lacking the requisite time, information (or patience?) to proceed through all the enrollment steps. In the end, just 36,000 consumers, or 1% of all those who attempted to register for the federal exchange, successfully enrolled in Obamacare.

Healthcare.gov was clearly unprepared to handle the huge spike in traffic witnessed on October 1st when it was visited by .9% (or 1 in 114) of everyone online in the U.S. This is roughly equivalent to the daily traffic on Target.com.

One area were Healthcare.org succeeded was in funneling consumers to state-run exchanges, which collectively averaged five-fold increases in weekly traffic during the first week of the month thanks to the 1.3 million visitors referred by healthcare.gov. Interest in these state-run exchanges varied by state and reflects differences across the country in terms of awareness and levels of uninsured.

Health Exchange Traffic and Reach

In Massachusetts, for example, where just 4% of the population is uninsured, traffic to its exchange was relatively low at just under 1% of the population. Of course Massachusetts has been operating an exchange for years so the impact of Obamacare is likely to be more modest that in other areas of the country. By way of contrast, 9.5% of Vermont’s population visited its exchange during that first week as the state seeks to shrink its ranks of uninsured below the current 9%.

Although healthcare.gov has had a rocky start, the fact that millions of Americans not only visited the exchanges but also took what actions they could to register and enroll suggests that demand indeed exists for new healthcare options. As the site improves and more consumers are able to progress through the enrollment process, the ranks of the newly insured will rise. In time, it will be up to consumers to decide how truly affordable Obamacare turns out to be.

This research is based on data from the Compete panel of 2 million US consumers. The data are weighted, normalized and projected to represent the US Internet population. For this analysis, we measured the number of people visiting various pages on Healthcare.gov, and then projected the incidence of this behavior.

About Matt Pace:
As VP of Millward Brown Digital’s financial services, retail and consumer products practices, Matt is responsible for vertical growth and strategy and the delivery of digital insights and best practice marketing consulting to leading Fortune 500 advertisers. Follow Matt on Twitter @mattpace.

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  1. Shelby

    How many, like me, don’t need new insurance but checked out both state and federal websites and tried to create dummy accounts to see how well they were working?


    • Matt

      I’d suspect there was a fair amount of browsing (and even dummy account creation), at least the first week, by those already insured and simply coming to check out the site and experience (or even contribute to) the poor site experience…probably all sorts of motivations. as we are now 17 days past launch, i’d suspect a much greater % of their current traffic is actually there to find out more about their coverage options.


    • Mike

      I did. I even did it in other states just out of curiousity. Just wanted to see how much it would cost me if I needed it in various states. I also found out I qualify for a subsidy…which I find completely ridiculous! I’m not rich by any means, but I sure make enough that I don’t need a subsidy.


  2. EpicFail

    Thanks for the analysis. Does this mean that 36K enrolled, or merely that 36K completed the online enrollment process? Those are two different things. It has been reported that a majority of applications “completed” on the federal exchange and sent to insurers have been incomplete or corrupted to the extent that insurers can’t issue a policy. If true, it may be that only a small fraction of 36K have enrolled via healthcare.gov.


    • Teresa in Fort Worth, TX

      Even more importantly, just what does “Completed Enrollment” mean?

      Does that mean that they submitted their personal information and are waiting for the next step, or does it mean that they actually signed up for a specific health insurance plan?


    • Matt

      good point. our focus was on on-site activity so effectively completed applications. we used that as proxy for enrollments, so the total finally enrolled could indeed be lower.


  3. Camden

    This is a very interesting analysis. Can you describe the methods and tools you used to gather this information, specifically your estimates for how many people enrolled in a plan?


    • Matt

      the analysis was based on the clickstream behavior of 2 million consumers in the US for whom we have premission to analyze their online browsing activity for research purposes. for this analysis we observed the tens of thousands of these panelists that visited various parts of healthcare.gov and then we normalized and projected the numbers to be representative of everyone online in the US.


  4. bill gmaz

    I don’t get why this is a big deal. It doesn’t begin coverage until next year and I can say my personal open enrollment has been available to view for a month and I haven’t even looked at it let alone make a decision.


    • Matt

      fair enough bill. certainly there is ample time for people to enroll before the window closes. the point we were making was simply that millions came and few enrolled, for various reasons. there has been ample coverage of the challenges he site has faced since launching and the public has been left to wonder whether a large or small % of the traffic signed up.


    • larrybud

      You have to buy insurance by Dec 15th for it to be effective for Jan 1, 2014. You have to buy insurance by Feb 14th, 2014, to avoid the IRS penalty for not having insurance.

      Frankly, I think you have to be nuts to sign up on the first year. The penalty is only $95. Sign up when you get sick. They can’t stop you, per the law, they accommodate all preexisting conditions.


  5. Marc

    I’m in Florida and after 10 days finally did get in to the site and am able to review the plan offerings.

    In my location – don’t know if this is statewide – there are over 100 different plans to select from. I have not enrolled simply because I need to take some time to evaluate each plan to see which would be the most cost efficient and responsive to my particular needs.

    I will be enrolling within the next 30 days.


    • marti

      You are lucky. I have tried at least a dozen times a day, everyday since OCT 1st. I am in Florida too and have yet to get into it. I tried calling them and even their own rep couldn’t log into their site. Don’t know how you did it.


    • Matt

      good point marc. i suspect a large reason why people who started enrolling but didn’t finish was for the reason you describe: lots to consider and people wanting to take the time to evaluate, get others’ opinions before making an important decision like this. i also think some people went to the site believing the enrollment would be more akin to selecting a cable TV package, and where overwhelmed with the amount of information needed to enroll and the options needed to wade through. like you, i believe many will come back, and are awaiting for the kinks to get ironed out .


    • Tommy

      ARRRGH! This is what kills me! All of you guys are going to the healthcare.gov website, doing your own research and then you are going to attempt to figure this thing out. Did you know there are many health insurance brokers (ok, maybe not many) that are really experts in the structure, plans, companies, and can help you walk through the analysis and decision making process. No, I’m not talking about your average sales guy, an expert. My point is that the prices are exactly the same (broker or not) and you might as well have help along the way in the buying, signing up, and also post ownership process.
      Yes, I’m an agent, and I will tell you it frustrates me to see people lost, confused, and full of information that is frankly flat out wrong. It is my firm’s mission to help people figure this out and know what they are getting and find the right plan for the right budget. Don’t do it alone, find an expert, probably a blogging agent in your state and get help, it frankly doesn’t cost anything more !


  6. Tom

    Actually, that headline is very misleading.
    A 0.4% conversion is better than what i’ve seen on some freshly launched e-commerce site where the product on offer is a lot less complicated than healthcare.
    Given the teething problems of the sites and the fact that people still have plenty of time to enroll i would consider these numbers very encouraging.


    • Matt

      interesting perspective. retailer conversion rates we see are typically in the 2-4% range, but i hear your point. the difference i see here is that unlike a new ecommerce site which has to deal with competition and cross shopping, in the case of healthcare.gov the audience is captive…there is only one place to shop. :-) the traffic is encouraging, the productivity of the site it’s first week was disappointing, but I suspect most will come back to complete the process so they can actually compare options and decide if the benefits of enrolling out way the costs.


    • tommy

      Yes, and most retail sites also don’t have a legal mandate requiring 35 million people to sign up within a 6 month time frame.


  7. Michael Lujan

    Very impressive analysis and dramatic headline, but not a fair or accurate prediction of the enrollment yet to come. It’s just too early to declare success or failure.

    While it is true the Healthcare.gov website was and still is a mess which needs to be fixed, most of the traffic is just getting information or checking it out.

    The enrollment deadline for Jan 2014 coverage is December 15th. I would not enroll yet either but expect many (like Marc and Bill) will enroll in Nov-Dec, even if by paper or telephonic application. Too much is being made of the technical glitches. It’s a massive undertaking to build an exchange (I helped build Covered California) but the program is not solely dependent upon web enrollment.
    In CA, 17,000 + licensed agents are also getting certified to enroll… on paper or the state website which seems to work fine here in CA.

    I think critics would say this is a massive failure if only 1 million of California’s 5.3 Million targeted get enrolled. I think the uninsured who finally get access to coverage would disagree. Getting even half a million enrolled in CA will be a major success!


  8. Michael Lujan

    It’s too early to declare success or failure. Most will not enroll until Nov-Dec. The program is not 100% dependent on technology (online enrollment) although the Healthcare.gov glitches are real and unfortunate. Still, there are 17,000 licensed agents getting certified in CA and willing to enroll on paper applications, if needed. That is how most enrollment is done today so it’s not a big change or inconvenience. Especially if you are uninsured and just need coverage. I predict close to 1 million will enroll in CA in the first year. Time will tell.


  9. Rick01

    If JPL can land the largest Mars rover in three years at a mission cost to get it successfully landed of $150 million, what does that say about websites that crash in the first week at a cost of $300 million and three years of planing? I’d say the unaffordable healthcare plan was a complete failure before launch years ago…


  10. name

    How many of the enrollees were Medicaid and how many actually will be paying premiums?


  11. Tony

    There seems to be some excitement about the fact 1 million people created accounts. Keep in mind initially you were forced to create an account to see plan designs and rates. That has changed now. You can see estimated rates. However, the estimated rate I saw was incorrect when I compared it to the actual exchange plan rate on the carrier’s website–to the tune of about $120 per month. Delay the mandate until the website is fully functional. You can still let people enroll who want to, but to force this on the American people when the component isn’t functional is ludicrous.


  12. CK

    I’m not sure why “% of State Population Reached” is an important metric when these Public Exchanges are focused on the currently uninsured. It should be % of Uninsured reached. For example, why would Medicare beneficiaries seek out this information??


  13. Rich

    Of the people enrolled, how many enrolled in Medicare part D and how many actually signed up for insurance where they will be paying? Seems like key data points are being left out here.


  14. RobertB

    If a majority of completed enrollments were corrupted, then it means that there are some very serious fundamental flaws in the database and/or hardware used to store/send them.
    It’s a lemon. Bad programs never really get fixed, because for each problem you fix, you get more things broken by the fix.
    Dump it. Start over. Or, better yet, dump Obamacare and let the individual states with their inhouse plans operate under a regulatory scheme.
    The State sites appear to be the only thing working.