HHS Doesn't Know How Many Uninsured Are Signing Up for Obamacare

"That's not a data point we are really collecting in any sort of systematic way," says a senior official.

Secretary of Health and Human Services Kathleen Sebelius speaks during an event in the East Room of the White House February 27, 2014 in Washington, DC. (National Journal)

There's a lot we don't know about how Obamacare enrollment is going. Apparently that's also true even within the Obama administration.

Gary Cohen, the soon-to-be-former director of the main implementation office at the Health and Human Services Department, stopped by an insurance industry conference Thursday to offer an update on enrollment. The main points were familiar: People are signing up (about 4 million have picked a plan so far), and the administration is going all out to promote Obamacare over the last few weeks of the enrollment window.

But Cohen didn't have much more to offer insurers — who need this to work just as much as the White House — on some of the biggest unknowns about the law's progress:

How many uninsured people are signing up?

The Congressional Budget Office estimates that the health care law will reduce the number of uninsured people by about 24 million over the next few years, and that about 6 million previously uninsured people will gain coverage through the law's exchanges this year. So, is enrollment on track to meet that goal? Overall enrollment is looking pretty decent, but how many of the people who have signed up were previously uninsured?

"That's not a data point that we are really collecting in any sort of systematic way," Cohen told the insurance-industry crowd on Thursday when asked how many of the roughly 4 million enrollees were previously uninsured.

New York state is collecting that data, and it says about 70 percent of its enrollees were not covered before, while about 30 percent are changing their coverage rather than gaining it.

How many people signed up directly with insurers?

When HealthCare.gov was broken in October and November, HHS and insurers agreed on "direct enrollment" as a workaround — encouraging people to sign up directly with insurance companies. It's also an option for people who are too wealthy to get a subsidy to help cover their premiums (the main benefit of using the exchanges), or who had a plan canceled and want to stick with the same carrier. Cohen was asked Thursday how many people have signed up outside the exchanges.

"I don't think we have done anything to try to collect that sort of data," he said.

How many people has the Medicaid expansion covered?

In states that went along with the law's Medicaid expansion, people are now eligible for the program with an income up to 133 percent of the federal poverty line. The administration provides overall Medicaid enrollment numbers, but those reports don't break out who is newly eligible, who was previously eligible but not enrolled, and who was simply renewing their Medicaid coverage through the exchanges.

This one, to be fair, is a little tricky.

It wouldn't be fair to the administration to assume that Obamacare only gets credit for newly eligible enrollees. There's a huge push underway right now to get people enrolled, and experts always recognized that, with such a big health care push going on in low-income communities, a lot of previously eligible people would get curious and sign up. It's called "woodworking" — people who already could have been enrolled but, for whatever reason, hadn't, until the Obamacare enrollment drive brought them out of the woodwork.