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The 10 States Most Critical to Obamacare's Success

Obamacare's health exchanges right now are like a four-lane highway that has three lanes closed for construction. Things are moving, but the chokepoint is causing traffic to move at a snail's pace.

We're a little more than two weeks into this grand experiment known as health insurance reform, and it's yielded both successes and failures -- even among the Fools I work with. For instance, I had almost no problems signing up online for health insurance in my home state while a colleague stared at the off-gray screen of death for more than 30 minutes without any success. It really underscores the mashed-together infrastructures behind the state and federally run exchanges and the condensed time frame under which information technology companies had to construct the highly complex architecture behind each exchange.

This week, we received our first glimpse at enrollment figures for the health exchanges managed by nine states and the District of Columbia. For the most part, they were weaker than expected given the numerous glitches most states have experienced, but also offer promise for the future that a good number of uninsured individuals are interested in obtaining affordable health insurance.

The 10 most important states to Obamacare's success
That's why today we're turning our attention away from the enrollment figures that the Department of Health and Human Services (which runs refuses to give us for the 36 federally managed exchanges. Instead, we'll dig into previously unreleased projections that The Associated Press has been able to obtain that'll give us a state-by-state breakdown of the government's anticipated Obamacare enrollment.

Overall, according to estimates and the AP, Obamacare aims to sign up 7 million people prior to the March 31, 2014, coverage cutoff date. Listed below are the 10 states that would be considered the most crucial to reaching that figure, according to the state-by-state enrollment breakdown estimates:


Projected Enrollment











New York






North Carolina




Source: Associated Press.

These 10 states alone are projected by the government to sign up 3.56 million currently uninsured people for health insurance, or more than half of the targeted 7 million new enrollees. Let's see if we can identify any marked similarities between these states, as well as look at what companies could stand to benefit from a surge in enrollments.

What these states have in common
Obviously, there isn't a blueprint that will encompass all 10 states listed above, but there are some notable similarities I see that are keys to Obamacare's success.

To begin with, many of the states -- with the exception of Texas, Georgia, and often North Carolina -- have favored the Democratic Party in recent presidential elections. We at The Motley Fool don't care about partisan bickering, but in this case it pays to note that states that backed President Barack Obama's re-election and his call for health reform are probably also a good bet to see the biggest number of new enrollees. It doesn't exactly explain the three aforementioned states, but it does help understand why we should expect strong enrollment figures from Oregon, Washington, New York, and California.

Another not-so-secret reason these states are crucial to Obamacare's success rests solely with their larger population totals relative to many other states. A large number of inhabitants will automatically draw more attention from insurers to these states, which will increase competition and potential advertising to gain new members. Simply put, more marketing means a better chance at reaching a broad audience.

Which stocks will benefit the most and which will miss out?
Perhaps the toughest role to play is that of the fortune-teller when it comes to predicting how many people will sign up for health insurance and, more importantly, when that'll happen. On paper it would appear that all insurance companies should benefit from a surge in new members, but common sense says some will clearly do better than others.

In the plus column, I can really only find one company that should, on paper, clean up relative to its peers: WellPoint (NYSE: ANTM  ) .

WellPoint, the company behind the Blue Cross Blue Shield Association, has set up shop in 14 states. Most notably, WellPoint is one of the primary insurers in California where it, Health Net (UNKNOWN: HNT.DL  ) , and Kaiser Permanente dominate the individual health insurance landscape, controlling a combined 75% of the market share. That's good news when there are potentially 1.3 million uninsured members up for grabs. WellPoint is also participating in New York, Georgia, and Ohio, giving it access overall to roughly 1.9 million of the projected 7 million new enrollees among the 10 most crucial states. Again, that doesn't guarantee WellPoint success, but it certainly gives it a strong edge over its peers.

In the other neck of the woods, we actually saw insurers like UnitedHealth (NYSE: UNH  ) , Aetna (NYSE: AET  ) and Cigna  (NYSE: CI  ) pulling out of participation in the health exchanges of highly competitive and densely populated states. All three companies bowed out of California's insurance exchange in May. Individually, Aetna also bowed out of New York, Ohio, and Georgia (which ironically are the same states where WellPoint could see big growth opportunities); Cigna exited the Pennsylvania marketplace; and UnitedHealth opted out of Pennsylvania, New Jersey, Illinois, and a handful of other exchanges.

These three insurers do have certain strongholds, such as Aetna selling policies in Florida and Pennsylvania, which have close to 700,000 forecast new enrollees. However, these insurers' cautious approach to jumping into the individual marketplace has the potential to backfire if the initial glitches and resistance to obtaining health insurance subside.

Then again, I do understand why these insurers decided to stay out of some of these bigger states -- they're predominantly focused on group-based insurance, not individual policies. In addition, many larger markets such as California are dominated by a few insurers. By sticking to the sidelines these three don't have to spend out the nose trying to establish a name for themselves against incumbent insurers, which will keep costs down in a very uncertain reform landscape. Also, based on the sheer number of glitches we've witnessed so far with the federally run health exchanges, it could take up to a year before we really see enrollments ramping up, which would mean that insurers that waited on the sidelines could swoop in next year without really missing a beat.

As usual, only time will tell if these prognostications prove true, but it'll pay for investors to keep a close eye on the swiftness with which the government tackles the fixes for the federally run

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Read/Post Comments (37) | Recommend This Article (4)

Comments from our Foolish Readers

Help us keep this a respectfully Foolish area! This is a place for our readers to discuss, debate, and learn more about the Foolish investing topic you read about above. Help us keep it clean and safe. If you believe a comment is abusive or otherwise violates our Fool's Rules, please report it via the Report this Comment Report this Comment icon found on every comment.

  • Report this Comment On October 17, 2013, at 3:56 PM, P51Mustang1256 wrote:

    7 Million??? I thought the pupose of government run insurance was to insure 40 million Americans without coverage. What about the other 33 million?

  • Report this Comment On October 17, 2013, at 4:10 PM, CathalMac wrote:

    You have got to be joking, only 7 million people? out of 350 million they only expected to cover 7 million by march? Thought they were suppossed to cover 40 million. Sounds like a typical federal gov. run program.....

  • Report this Comment On October 17, 2013, at 4:16 PM, Dayo2 wrote:

    On Obamacare, seems that the middle class and above on their previous self payments on medical insurance have become two to three times higher with Obama care. Now the eleven million illegal immigrants that are considering being citizens soon and the ones previously are going to get a lot more medical procedures in the U.S. due to this. It is no wonder that mental war procedures among those 535 persons running this country is happening today. The one percent seems to have control over them for profit. We need to go with the part of the constitution that says we can sign petitions and replace all present day 535 persons at any time. We need a worldwide balance of the ten commandments from the heart up giving more that we take and standing up for that, not from power nuts from the top down on using power profiteering rather that competive profiteering. We could use some highly successful technology personal to take over for months and a few years, rather many years. We need to learn to get along.

    We need to bring in the top medical persons from the top five countries to take the medical procedures over and away from the one percent and those 535 persons working for them directly or indirectly and controlling our medical profiteering. At the present the U.S. is Thirty eight down among forty five nations. . If you entered a hospital with an illness that cost approximately six thousand for one illness and then anther enters another hospital with the same illness and procedures the cost would be approximately eighty thousand. This is what is happening and has been for several years and those people that are supposed to be standing up for us are not.



    Medical ones


    Generation RX by Fred A. Baughman, Jeanette and Peter Blabrough

    The Business of Being Born



    (Zeitgeist) by Peter Joseph, Robert Sapolsky, Gabor Mate

  • Report this Comment On October 17, 2013, at 4:26 PM, mapsguy wrote:

    If the right wing of America genuinely cared about ALL Americans, they would jump on this bandwagon and help to make this the best healthcare plan in the world. The fact is, they don't.

  • Report this Comment On October 17, 2013, at 4:27 PM, mapsguy wrote:

    The 10 Commandments? Seriously?

  • Report this Comment On October 17, 2013, at 4:29 PM, kimdi01 wrote:

    Wonder when they, the government, will breakdown the numbers to show how many of those "signed up" are illegal aliens. I'd be willing to be them majority of those in Texas and California are of that group.

  • Report this Comment On October 17, 2013, at 4:41 PM, entitled wrote:

    So, how many of these unfortunate people/families lost their employee HC and were thrown into these exchanges by force? Is that factored in?

  • Report this Comment On October 17, 2013, at 4:42 PM, annrand wrote:

    lets see if the sickest among us dominate the obamacare enrollees then the insurance companies are going to take a bath on the program. could that be why aetna and cigna etc opted out?

  • Report this Comment On October 17, 2013, at 4:43 PM, gadeko wrote:

    The health exchanges are moving. Really? What is the author smoking? CNBC reported a paltry 0.4% or 36,000 people have signed up out of wait for it...almost 10 million people that got onto the first week. That's abysmal. Where are those 15 million people Obama said were clamoring for health insurance? So far the site has mostly attracted curiosity seekers and tire kickers. And, here's the rub, once the curiosity gives way to reality and the new wears off they're going to get even fewer hits on the site. The only chance they had was to get as many people signed up as possible at the outset. But they blew it. This thing is going to crash and burn. Yet another gigantic waste of taxpayer money just like every program Obama wasted our resources on.

  • Report this Comment On October 17, 2013, at 5:02 PM, iamsamual wrote:

    okay, its real simple. if you live in one of the above mentioned states, don't sign up. don't even try to get a login account.

  • Report this Comment On October 17, 2013, at 5:03 PM, kramerfan2 wrote:

    for the love of God mapsguy can't you libs discuss anything without demonizing Republicans and demogoguing the issue? Sheesh

  • Report this Comment On October 17, 2013, at 5:03 PM, horticultor wrote:

    Lowering the bar, the only way the Obama Circus has survived this long, rolls on.

  • Report this Comment On October 17, 2013, at 5:15 PM, gadeko wrote:

    By the way, how come Aetna and Cigna can opt out of the system but we can't?

  • Report this Comment On October 17, 2013, at 5:16 PM, donkeyote12 wrote:

    (partisan free post)

    The markets have this odd relationship with values. Wellpoint from what I can tell is one of the primary reasons why healthcare is so high. A classic middle layer that sucks out money that otherwise would lower health care costs. Pre Wellpoint Blue Cross of CA seemed fair and sane. Now it;s just a pain, both to the wallet and the mind. I guess what one needs to think of doing is hedging the health care costs by investing companies like Wellpoint, but that also seems insane. Where, for God's sake is the sanity anymore. Why do we have decent providers in non-profit hospitals and the like and such a cut throat corporation like Wellpoint sucking the blood out of the system. This article is probably correct that Wellpoint is a good play, but play I not in this de-moralized segment of the free and sanity starved market. Oh I could go on ...

  • Report this Comment On October 17, 2013, at 5:23 PM, rfccac2003 wrote:

    Visited website today at 5:00pm EST.

    A little slow but well designed and easily navigated.

    The naysayer/bigots are going to cringe when this program is successful. Give 12-18 months and watch the membership grow

  • Report this Comment On October 17, 2013, at 5:30 PM, foolishlymeek wrote:

    What companies will be offering concierge medical treatment? That's where the huge growth will be in the future!

  • Report this Comment On October 17, 2013, at 6:04 PM, brianh1966 wrote:

    I applied at this morning. The site worked fine. I got an answer within minutes. I more than qualified for low or no cost health insurance at the Federal level but the state of Florida declines to help people in my "situation" as they put it. So the message I got was the Federal Gov't wants to help you but the State of Florida says you are on your own. no help for you. They said i will not be penalized for not having health insurance because they are turning me down. I am supposed to be appreciative of this? cause I'm really not. The state of Florida gets an F in my opinion of helping low income people get health insurance.

  • Report this Comment On October 17, 2013, at 6:32 PM, captaintodzilla wrote:

    enlightenment finally after watching Swipe yo EBT (It's Free) on you tube everything fell into place. now that the middle class has been eradicated the united states are truly united once again now we are left with the rich and the poor that equally agree on greed ignorance and self-entitlement. both parties the rich and the poor demand something for nothing are good for nothing have no morals and only care about themselves. actions speak louder than words.

  • Report this Comment On October 17, 2013, at 6:32 PM, captaintodzilla wrote:

    enlightenment finally after watching Swipe yo EBT (It's Free) on you tube everything fell into place. now that the middle class has been eradicated the united states are truly united once again now we are left with the rich and the poor that equally agree on greed ignorance and self-entitlement. both parties the rich and the poor demand something for nothing are good for nothing have no morals and only care about themselves. actions speak louder than words.

  • Report this Comment On October 17, 2013, at 7:35 PM, JiminELP wrote:

    Yes, sit back and watch the enrollment grow ... of course the fact that it's forced enrollment is besides the point. They are projecting 7 million for the initial enrollment and ramping up to 21 million at the 10 year point. Originally advertised to provide insurance for 35 million but hey, that's only 14 million short, right? Well, not exactly ... the CBO is projecting 11 million previously insured on employer provided healthcare will loose their insurance so after 10 years we are at a net gain of 10 million people insured. Well, that's not too bad for the $800 Billion that President Obama said it would cost, $80,000 per person gained but the CBO says the cost is now projected to come in around $2.4 Trillion, so that's $240,000/person added to the insured roles. This is not designed to succeed, it is designed to progressively raise fines until people have no choice but to be a part of the exchanges and then as the civillian insurance industry collapses under the weight of the ACA Big Brother can ride in, initiate a single payer healthcare system and rescue the healthcare industry ... you know, Socialized Medicine that is working so well in europe and the UK and elsewhere, the "public option" that even the majority of Democrats wouldn't allow in the ACA in 2010 because of the financial crises that it would cause on our National Debt ... yes, that will be the solution. In the mean time people are getting part time jobs with full time bills, small businesses are reluctant to grow because of the huge increase of operating cause once the exceed the 50 employees to mandate the ACA Employer mandate (still delayed a year, but it's coming). Yes, this is causing middle class and higher income families to triple their premiums in some cases and if you are young and healthy, what was costing $90/month will cost you $200 easy. Don't worry though, it's just another method of redistributing the wealth so that the old and sick can get a little cheaper than they would under the current system. It was funny the otherday when a comentator on a newschannel said that over 80% of the people get employer provided healthcare and then there are those on government programs like Medicare, Medicaid, TriCare and CHAMP-VA so those that are looking at actually paying more is only 10-15 million people out of over 300 million ... a really small percentage. Now, with that in mind, consider the net gain in insured over 10 years as projected by the CBO of 10 million ... does anyone else see the irony in his comment?

  • Report this Comment On October 17, 2013, at 7:42 PM, mikesboat6 wrote:

    The only people you can blame for this is the Democratic Party. They’re the ones who designed it and passed it just for you. You can’t blame anyone else; oh I’m sorry yes you can Obama. The best thing to do is put the right people into office to get rid of this massive cost to the American people. Any buddy but a Democratic. This is why the Republican Party was against it from the beginning. The Federal government has never been able to run anything. If you don’t take anything from this, remember nothing is for free and if it’s too good to be true it probably is and if you think the government can make something cheaper, you need to read your history books.

  • Report this Comment On October 17, 2013, at 9:12 PM, 2smartforlibs wrote:

    I see one White House intern on here doing his overlord bidding. The best we can hope for is the impossibility to fund this bring the entire left wing down

  • Report this Comment On October 17, 2013, at 9:36 PM, mimiw wrote:

    Yeah, this is great stuff. If I changed to an ACA policy, my premium would go up 200$ per mo. Where's the "affordable"?

  • Report this Comment On October 17, 2013, at 10:25 PM, rw93003 wrote:

    Only one state is needed. The state of ignorance. A state of mind that allows one to believe that the government can provide exactly the same benefits for 3 to 30 million more people for less money---or the state of mind that allows one to gladly accept much less for much more.

  • Report this Comment On October 17, 2013, at 10:29 PM, TexasBob86 wrote:

    Thank you Governor Perry and Texas Republicans.

    I'm a retired 63 y/o male and life long Texan.

    On the Kaiser Obamacare Web site I learned that I'll have to spend 49+ percent ($6,350) of my annual income for health care coverage on the exchange.

    If I lived in Minnesota, I'd be covered under Medicaid.

    You stand on principle and I get my income cut in half.

  • Report this Comment On October 17, 2013, at 11:00 PM, EatMorChikn wrote:

    Hmm, They want to enroll 7 million?? But, as of Oct. 1, 2013 I got a letter from my Healthcare Insurance Company that states my policy will no longer exist after Dec. 31, 2013?? Now my options are to re-apply for coverage under a different plan with the same company or find insurance elsewhere! The policy I now have does not meet the coverages mandated by Obmamcare! All that talk of keeping your same plan if you like it?? or can afford it?? I think there should be reprecussions for misrepresentations!!

  • Report this Comment On October 17, 2013, at 11:16 PM, DaSky wrote:

    Socialism never succeeds over time!

  • Report this Comment On October 17, 2013, at 11:28 PM, EatMorChikn wrote:

    So, Texas Bob86 move to Minnesota! (The part you are missing is it wasn't Perry's or the Republicans Deal!) You had to vote for it to see what was in it - if IT stands YOU HAVE TO LIVE WITH IT!!!!!!!!!!

  • Report this Comment On October 17, 2013, at 11:37 PM, EatMorChikn wrote:

    Da Sky - If we could just get all those Socialist loving people to relocate to those Socialist loving Sates? Then we could give California to Mexico and the North East States to Canada! :) Maybe Florida could become a colony of Cuba??

  • Report this Comment On October 18, 2013, at 12:00 AM, Widowmaker6 wrote:

    do not expect North Carolina to sign up - only a FOOL would put their personal information on an obamaz website

  • Report this Comment On October 18, 2013, at 12:43 AM, ObamaWhackJob wrote:

    Which one of you All FOOLS are planning on putting all of your Private Information on a OBAMA site first..

    You will find me off GRID...

  • Report this Comment On October 18, 2013, at 12:47 AM, ObamaWhackJob wrote:

    Can some one please remove the AFFORDABLE out of the ACA, it is kind of getting under my skin.....

    But it sounds nice at least.

  • Report this Comment On October 18, 2013, at 12:49 AM, ObamaWhackJob wrote:

    ACA the gift that will keep on giving to the Republicans...

    We have something to blame on the DEMOCRATS for the rest of our lives...

    Expensive but maybe it is worth it..

  • Report this Comment On October 18, 2013, at 12:51 AM, ObamaWhackJob wrote:

    I think the government will be able to use there money grows on trees, to pay for all of this...

    Keep on spending like Drunken Chicks at a Shopping Mall, it is not your money...

  • Report this Comment On October 18, 2013, at 2:39 AM, misterfrost wrote:

    Seems like the government has forced the 99% to become customers to the 1% again..and this time if you don't play'll be penalized..

    Now correct me if I'm wrong but isn't that more fascistic and corporatist than it is benevolent and capitalistic.

    Come on Fool..tell us how we are still a capitalist nation even though corporations pay the politicians to pass the majority of the laws..

  • Report this Comment On October 18, 2013, at 4:31 PM, JackTroy wrote:

    The enrollment numbers are abysmal. But that could actually be a good thing for Obamacare. It looks like the "motivated buyer" of Obamacare is someone who has a health problem that has been difficult to insure. That means "high care use" buyers who take much more than they give into the system with their premium payments.

    Saying that the Obamacare program is experiencing "glitches" is like saying the Titanic experienced "setbacks" on its maiden voyage. Not only is enrollment way less than expected the quality of enrollers could bankupt the program since they are getting a very expensive "free lunch."

  • Report this Comment On October 18, 2013, at 7:29 PM, JePonce wrote:

    Obamacare is not about health care.

    It is about writing law aimed at destroying the Constitution, such as the 4th Amendment guaranteeing our right to privacy, eliminating warrant, and eliminating due process. It is about increasing the power of the federal government by decreasing the power of the citizens. It is about raising existing taxes and adding new Obamacare taxes on the middle class. It is about adding more citizens to our already immense welfare state. It is about further control over the behavior of citizens through regulation. It is about moving $5.1 trillion in U.S. capital produce by the insurance and health care industry each year from the private sector to the Obama all-powerful, central-planning Politburo.

    It is about establishing a dictatorship, plain and simple.

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