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These 5 States Are Obamacare's Biggest Roadblocks Thus Far

It's been two and a half months since the Obamacare health exchange marketplaces opened for business and sign-ups are slowly beginning to pick up the pace, according to the Department of Health and Human Services. The agency last week released enrollment data through the first two months.

With the federally run website proving nonfunctioning for many consumers in the 36 states which its serves, and even some state-run health exchanges still working out their own glitches, total enrollment is pacing well below HHS' goal of enrolling 7 million currently uninsured people by the March coverage cutoff date.

Through the first two months, 364,682 people had signed up, with an additional 803,077 people being determined eligible for Medicaid or Children's Health Insurance Program assistance. The number of people who completed the application process but had not yet selected a plan grew by 1 million to 1.9 million.

There are two ways of looking at this data. From the optimists' perspective, having 39 million people visit the Obamacare website and 1.9 million people complete the arduous application and identification process clearly shows interest by uninsured people in obtaining health insurance. It seems unlikely that this group of people would complete the application process on a lark, so you can likely expect these applicants to become full enrollees as the March coverage cutoff approaches.

However, from the "glass half empty" perspective, you can't count your chickens until they're hatched, and 364,682 full enrollees over two months is pretty paltry. Furthermore, the bulk of the sign-ups are likely to be people who are the sickest or most in need of care and those who qualify for Medicaid due to their income. Without the addition of young adults to Obamacare, insurers will not be able to maintain the rates established this year and we'll see costs potentially move significantly higher beginning next year.

Five states holding Obamacare back
Yesterday we looked at five states that, through the first two months, have contributed 55.5% of all enrollments. Today, we're turning the tables and looking at five states that were major stumbling blocks for Obamacare through the end of November.

These five states are: 


Number of Full Enrollees



North Dakota


South Dakota






Source: Department of Health and Human Services (link opens PDF).

Cumulatively, these five states managed to enroll just 1,510 people through two months. That is pretty miserable considering that Vermont's state-run health exchange has been practically nonfunctional -- and the state has the second-lowest percentage of uninsured residents in the country, behind only Massachusetts -- yet it's still been able to enroll nearly 5,000 previously uninsured people.

There are certainly a few similarities worth noting here.

First, lower-populated states would be logical choices to bring in a smaller number of enrollments. This is why figures from Alaska and North Dakota are understandable, but states like Oregon deserve a wag of my finger! But more so than just total enrollment, all five states are significantly below the national average of signing up 20% of total applicants. With the exception of Oregon, which is trolling along at an abysmal 0.2% enrollment-to-full applicant rate, the remaining four states above are only enrolling between 10% and 15% of people who have completed the application process.

Secondly, technical issues are still a big problem. Obviously, the fix to should help remedy sign-ups in North and South Dakota, Delaware, and Alaska, but the Oregon fiasco is entirely on the state and its independent contractor, Oracle (NYSE: ORCL  ) . Oregon has certainly had its fair share of Medicaid enrollees, according to the Oregonian newspaper, but the shortcomings in the state's online health exchange have led to top website officials stepping down and some 20,000 people potentially losing their coverage on Dec. 31 with little chance of getting insurance by the coverage cutoff date. 

Who's losing out?
The clear loser here would be any hospital or outpatient center operator that has exposure to these five states. Hospitals are counting on more people to be insured, which theoretically should lower their annual revenue write-off for patients who couldn't pay for services rendered. Specifically, small hospital operator Select Medical (NYSE: SEM  ) has hospitals in South Dakota and Delaware, as well as physical therapy facilities in Alaska and Delaware. If these states continue to demonstrate weak enrollment, Select Medical's bottom line may see only a marginal bump higher. 

The other big loser in this process has been federal and individual state contractors. Despite successes in California and New York, as well as the completion of's fix for a majority of citizens, the onus of blame for much of the technical glitches associated with these websites falls on the contractors.

Canada's CGI Group (NYSE: GIB  ) , for example, might win the award for most finger-pointing amassed in one year for a private enterprise. CGI Group is the contractor responsible for building and is also the primary contractor behind Vermont's predominantly nonfunctional health exchange. These low figures, even if they are from Oregon and other federally run states, reflect poorly on the information technology infrastructure sector as a whole, and especially on CGI Group, which could lose future orders over this debacle.

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Read/Post Comments (42) | Recommend This Article (12)

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  • Report this Comment On December 16, 2013, at 2:21 PM, floydhowardjr wrote:

    America If you lose your coverage, your doctor, your insurance BLAME a Democrat. Next time you go and vote...remember WHO did this to YOU! DEMOCRATS!

  • Report this Comment On December 16, 2013, at 2:37 PM, poornamelessme wrote:

    Unless you live in a state that has a working exchange ... get insurance now that is less expensive than before, and it still covers the same doctors you had before.

    There is so much gloom and doom posted about affordable care, but in reality, for states that have a working exchange, there are also people who have benefited a great deal.

    If you lose your coverage, doctor and insurance, blame your state govt. as they can allow insurance companies to provide the same insurance they offered previously ... but it's up to each state to allow it, or not. It's also fair to blame them if they have a local exchange that isn't working at all.

  • Report this Comment On December 16, 2013, at 2:37 PM, SkepikI wrote:

    Sean: My advice to you is to drill down into the statistics more vigorously. You and others should be more skeptical, as am I (imagine that!) about what constitutes "signed up" and if the numbers mean anything at all. Case in Point, Oregon. The numbers cited, 44, slim though it is has been shown to be a bit of fakery as NO as in zero "sign ups" actually have insurance. Because no money has changed hands. Because the "signups" enrollment data has not made it to the insurance companies. Because the paper applications (the website does not work and data is not going to the insurance carriers) have not made it to the carriers -as of Friday. AND therefore no enrollments have actually come out of "sign ups"

  • Report this Comment On December 16, 2013, at 2:41 PM, Veggieman wrote:

    800,000 FREE policies 300,000 pay policies !! Sounds a little screwed up to me !!

  • Report this Comment On December 16, 2013, at 2:42 PM, Mathman6577 wrote:

    I don't think the states (really meaning the people that live there) are impeding Obamacare. I think it is the other way around.

    And I agree w/ skepikl. "Signing up" doesn't mean you have insurance -- you still have to pay for it and get a confirmation.

  • Report this Comment On December 16, 2013, at 2:50 PM, Factual1804 wrote:

    How come you only show 5 States? Why not showing all of the other States? I assumed that you are in the business of educating people by giving them the fact; if i am correct!!!

    Proverbs 19:9...

  • Report this Comment On December 16, 2013, at 3:00 PM, rickochey wrote:

    Obamascam is not about 'financial assistance' to see a doctor. No one is exempt. Not even Bill Gates. Does Bill Gates need financial assistance to see a doctor?... so guess what its really about.

  • Report this Comment On December 16, 2013, at 3:17 PM, fooledusall wrote:

    243% of 1 is 243.. big accomplishment.. wait until november of next year when companies will start dumping employess...

  • Report this Comment On December 16, 2013, at 3:23 PM, DonkeyKong wrote:

    The Republicans are going to make an issue out of 'the failure of Obamacare' as long as possible, thinking it will help them gain control of the Senate in 2014 & the White House in 2016. The problem is, voters are more likely to remember the government shutdown and associate that fiasco with the Republicans. Also, in 2016 the Republican party will be nominating a Presidential candidate so far to the right that they will be unable to win an election against a moderate Democrat. The end result: Hillary in 2016 along with a Democratic House & Senate. The fighting within the Republican party is going to be their downfall, and they only have themselves to blame.

  • Report this Comment On December 16, 2013, at 3:25 PM, jhuytg6767654 wrote:

    Here are 196 reasons why hypocrite politicians and unions that support Obamacare want exemptions for themselves

  • Report this Comment On December 16, 2013, at 3:41 PM, DonkeyKong wrote:

    Looks like this squirrel has been gathering nuts for quite a while.

  • Report this Comment On December 16, 2013, at 4:07 PM, obamabinbiden wrote:

    Actually, your statement of Hospitals and Out-patient Centers losing out is incorrect.

    I work in a hospital and these individuals will just transfer from "Charity Care" to "Bad Debt". With a $5,000 deductible, none of these individuals will pay their healthcare bill over their utilities. So there will be little to no difference in healthcare facilities receiving payment.

  • Report this Comment On December 16, 2013, at 4:10 PM, DDGriffin1954 wrote:

    It does not matter about any of the reasons people think this is awful the simple fact is if it is not good enough for Mr. President and that bunch it is not good enough for me, period.

  • Report this Comment On December 16, 2013, at 4:12 PM, SkepikI wrote:

    @DonkeyKong- well, at least there is no gathering of crooks, crony "managers" and fraud...

  • Report this Comment On December 16, 2013, at 4:58 PM, FJKSr wrote:

    Obama is ObamaCare's biggest obstacle. He has lied so many times about this program that not even the fools that voted for him believe him anymore.

  • Report this Comment On December 16, 2013, at 5:03 PM, rwhprism wrote:

    Up this or that percent is the admistrations way of avoiding the real numbers. 1 million people enrolled in a nation of over 300 million people is 1/3 of 1%. 99.6% haven't enrolled and dont want it.

  • Report this Comment On December 16, 2013, at 5:20 PM, FJKSr wrote:

    For any of you fools out there that believe this was ever about "affordable care", you need to do your research on Obeyme. This has always been about income redistribution, taking down of the middle class and the establishment of Socialism in the U.S.

  • Report this Comment On December 16, 2013, at 5:25 PM, clutch1958 wrote:

    @Donkey-the GOP 's final bill funded all of government in return for a 1 year delay, and Obama and Reid said no. The shutdown (which was only 15% of the government, BTW) is entirely on them. Also, Obama ran as a moderate, and look at him now. Of course, anyone that would believe that Hillary Clinton is a moderate hasn't paid attention and/or done any research.

  • Report this Comment On December 16, 2013, at 5:26 PM, stevmg wrote:

    Oregon and Delaware are Blue States and could help Obama - some. But they are relatively small in population.

    Remember, there is no way that by

    1) covering currently uninsurable

    2) no disqualification of pre-existing conditions

    3) keeping adult children on family insurance until they reach the age of 26.

    4) no caps on coverage

    5) no dropping of insured from coverage because they are too sick

    can insurance premiums go down. The 26 year old portion, though, would be a very small increase in benefits paid out as these are healthy people.

    We MUST include all for healthcare, otherwise we are two nations: a very modern one, and a third world one.

    I prefer to be in a 21st Century nation, not a 19th Century one. I don't want my old, 19th Century country back.

  • Report this Comment On December 16, 2013, at 5:28 PM, TheUnaballer wrote:

    Just want to point out that this article states that Massachusetts has the highest percentage of uninsured residents...and if that's true, why in the world was it used as a model for ACA???

  • Report this Comment On December 16, 2013, at 6:04 PM, mymoot1 wrote:

    First, the "fool" has become an obamacare promoter, 2, they are propping up a humpty dumpty; 3 more now, than ever, we can all finally see that even the best of intentions can go to hell when it comes from ANY government, 4; help UNDO obamacare before it metasterzises further by electing the GOP, no matter how you don't like them, 5... need I say more?

  • Report this Comment On December 16, 2013, at 7:15 PM, joegoldner wrote:

    80% of those were medicaid and will bankrupt the states and the country. Plus how do we really know that they really have coverage? The back end has not been built yet. Plus with no security built in, how do you know that your identity was not stolen

  • Report this Comment On December 16, 2013, at 7:48 PM, MS wrote:

    So whats wrong with being smart enough not to sign up?

  • Report this Comment On December 16, 2013, at 8:23 PM, energizedat54 wrote:

    The roadblocks to healthcare haven't scratched the surface...

    After scrutinizing the new plans offered by Care-first BCBS in Maryland, I have learned that at ages, me - 54 and my husband - 61 respectively, our periodic prenatal visits are free of charge and our blood work for prescriptions is essentially uncovered... that is until we reach our deductible of $3,500.00 per person coupled with a $655.00 monthly premium. That December 12, 2013 online quote is defined as the "Bronze" Obamacare PPO Plan offered by Carefirst in MD.

    Just recently, I visited my doctor in Carroll County, MD for a prescription renewal, one for which he ordered blood work. The blood work cost me $370.00 and the doctor's visit $120.00. I was billed $490.00 not including the $20.00 prescription that I've been taking for ten years for a Hypothyroid condition. I'm relatively certain that the doctor had no idea how much that blood work cost.

    Needless to say, I've requested my entire 30 year medical file in order to scrutinize the history of the blood work, the test results, etc. to negotiate directly with the doctor and these labs before I go completely broke.

    Managing my little condition speaks nothing of the significant conditions, with which many suffer. The order of the day is one of taking charge of my own medical care and managing it myself. That's where we are, like it or not.

  • Report this Comment On December 16, 2013, at 9:26 PM, bradflashj wrote:

    It is essentially irrelevent what your premium is if your deductible goes up. I had a so-called bad policy that was cancelled. It was $1,100. per month with a $1,500 per person deductible. So, my wife and I faced the possibility of $13,000 in premiums and $3,000 in deductible. Now we have to pay $850 per month but have a $5,000 per person deductible for similar coverage. That means $10,200 in premium and $10,000 deductible. That means an extra $4,200 per year in out of pocket expenses. The way I look at it, Obama and Obamacare are taking $4,200 a year from me and giving it to someone else who has not earned it (didn't say they don't deserve it, just said they didn't earn it). Doesn't anyone see the problem in taking from those who will earn and giving it to those who won't? It appears like you are moving toward fairness or equality, but you are not. It is not fair for me to earn and pay for my health care and then just give it to someone else.

  • Report this Comment On December 16, 2013, at 10:18 PM, SwK0212 wrote:

    I'm from Delaware. I should point out that we only have 3 counties in this state and New Castle Co. is the only solid "Blue" in this state but because they hold the largest amount of the population they hijack the entire state politically from its "Red" leaning counties in the south of the state. New Castle Co. is also has the worst crime rates in the state and has the largest amount of people on state assistance. So now you know why they lean Blue in every election. That is also the County that created Joe Biden so please stop looking unfavorably at my state. Just look unfavorably at the north half. Thank You.

  • Report this Comment On December 16, 2013, at 10:49 PM, thecarnivore123 wrote:

    Everyday the Motley Fool writes at least one pro-Obamacare article. And everyday, the masses point out all the misstated facts and obvious bias. Let me give you a serious tip - start writing about this law getting repealed. Because that is what is going to happen.

    And the funniest thing is, the Democrats are going to be the ones to repeal it.

  • Report this Comment On December 16, 2013, at 11:04 PM, Nikkiknows wrote:

    As some have pointed out, there is a disparity between the 803,000 who will get free coverage and the 365,000 who may purchase a policy. But it is worse, much worse than that awful ratio looks.

    Suppose a plan will be $500/mo = $6,000 per year. That means, the 803,000 will cost $4.8B a year. Pick any kind of regression analysis parameters, and presume what percent of the 365,000 will be subsidized, and how sick they will be. Suppose 2/3rds of the 365,000 will get an average of 1/2 subsidy. That is another $1.5B cost. Being sicker than average, means the average cost of healthcare (not the policy) of $6k/yr, is probably not right, but is probably double that, so that is another $1.5B.

    That means the 1/3rd of 365,000 who are young, healthy, and have a good job, 122,000 will be burdened with an extra $7.8B to cover those not paying their way. So, for the program to work out in cost, those 122,000 will have to have their premiums increased to roughly $70,000 per year for Obamacare to break even.

    Just by estimating, we get a foolish result that the healthy person who makes a good living will have to pay about $70,000 a year for health insurance in Obamacare so the program remains solvent.

    This is just a back of the envelope guess, but the result is so far off from solvency that there is no way Obamacare could work.

  • Report this Comment On December 16, 2013, at 11:09 PM, Nikkiknows wrote:

    energizedat54 pointed out that she will get free prenatal visits. If she does not enjoy those prenatal visits, she can also get free birth control pills.

    Yes, I read your age.

  • Report this Comment On December 16, 2013, at 11:32 PM, clloyd53 wrote:

    It seems that the media is interested only in the number of people that join Obamacare. And have no interest in whats best for the working man and woman.

  • Report this Comment On December 17, 2013, at 12:40 AM, mm4AUTigers wrote:

    Good for you Oregon. The rest of the country should follow your lead.

  • Report this Comment On December 17, 2013, at 1:32 AM, dannyo1966 wrote:

    Just remember exactly who gave us this train wreck folks.

    1. No Republican in eather the US House or Senate voted for Obamacare. They have however, sent several bills to the US Senate to eather eliminate the program, or to amend it, none of which Harry Reid is planning on bringing to the Senate floor for a vote.

    2. Nancy Pelosi had to change the House rules in order to get the bill to pass. Too many Democrats had decided to vote against Obama care. She also told us this bill needed to be passed so everyone will know what is in it. Hey, thanks there Nancy.

    3. Obama PROMISED that "If you like your healthcare plan you can keep it. Period. If you like your doctor you can keep him......PERIOD!!!!!!"......

    I guess it depends on what your definition of period is.

    4. Obama has already, contrary to his own law, granted exemptions from Obamacare to his corporate buddies, Democrat members of congress staff.

    5. The whole basis of Obamacare is the hope that the young and healthy among us, those that really don't feel they need to have healthcare expenses at this time of their lives, will go on Obamacare, and will agree to pay ridiculously high insurance premiums, to offset the rest.

    This is a house of cards that will crash down at the slightest gust of wind that hits it. Its a TRAIN WRECK. Vote Republican in 2014.

  • Report this Comment On December 17, 2013, at 12:16 PM, mewp12 wrote:

    donkey, just who was affected by the shut down. basically they furloughed unimportant federal workers and shut down places to tourists. No one even remembers it.

  • Report this Comment On December 17, 2013, at 1:41 PM, bugmenot wrote:

    Even the liberal comedian Jon Stewart described Obamacare as a clusterfck. It isn't the website. That is just pure incompetence from the White House. There is no payment plan for sign-ups! Companies and People will be charging Barack Obama with Felony Insurance Fraud. States will be backing these people with warrants for the arrest of Barack Obama, Nancy Pelosi, and Harry Reid for Felony Insurance Fraud. The three Democrat Stooges will spend the rest of their lives in jail and in a court of law as individuals will be allowed to file the felony case against each. There could be 20 million court cases with Obama in jails and an orange jump suit!

  • Report this Comment On December 17, 2013, at 1:43 PM, Kngrthr wrote:

    Admit your mistakes, apologize to the American people, ditch the obammycare and move on. The American people would actually respect you but we all know you don't care, you only care for governmental control of the people.

  • Report this Comment On December 17, 2013, at 2:16 PM, warpig6558 wrote:

    On December 16, 2013, at 2:37 PM, poornamelessme wrote:

    "Unless you live in a state that has a working exchange ... get insurance now that is less expensive than before, and it still covers the same doctors you had before.

    There is so much gloom and doom posted about affordable care, but in reality, for states that have a working exchange, there are also people who have benefited a great deal.

    If you lose your coverage, doctor and insurance, blame your state govt. as they can allow insurance companies to provide the same insurance they offered previously ... but it's up to each state to allow it, or not. It's also fair to blame them if they have a local exchange that isn't working at all."


    Pull your head out of the sand poornamelessme and look at my reality... my healthcare premium 25% higher & deductible is 65% higher, and now I have to travel 100 miles to get a doctor that is in the new plan being offered. All of my doctor visits will be considered out of network and will have a $60 co-pay to boot.

    If everything was working as you claim, why is everyone paying more.

    -CBO: ObamaCare Price Tag Shifts from $940 Billion to $1.76 Trillion.

    -The CBO estimates that 4 million Americans will lose their employer-sponsored health plans by 2016, a far cry from the 1-million-person figure forecasted last year. Further yet, 1 million to 2 million fewer people will be granted access to the federally-subsidized healthcare exchanges, while an additional 1 million are estimated to qualify for Medicaid and the Children's Health Insurance Provision.

  • Report this Comment On December 17, 2013, at 4:30 PM, Michaellaborde wrote:

    Oregon supported Obamacare and now only 44 people have enrolled? Give me a break. You are not guaranteed that if you enroll that they have you in the system, there is no setup to pay the doctors yet and , if you manage to get through all of these hurdles , most will pay higher premiums and higher deductables , while those on welfare suck off of the middle class worker.

  • Report this Comment On December 17, 2013, at 4:57 PM, tylerjozefowicz wrote:

    There are about 48 million uninsured Americans. Bottom line , the Republicans have no plan to insure any of them.

  • Report this Comment On December 17, 2013, at 6:13 PM, miteycasey wrote:

    It couldn't be the people electing not to take the health care because the penalty for not taking it is cheaper than the health care. Also they can keep going to a Emergency room as they have been doing before.

  • Report this Comment On December 17, 2013, at 7:39 PM, Mathman6577 wrote:

    Tyler: It isn't up to the GOP to fix healthcare or have a plan. The left-wing created the mess and they have to fix it.

  • Report this Comment On December 17, 2013, at 7:41 PM, FuturewwIIIvet wrote:

    I'm still not sure how the insurance companies can remain in operation if they have had to cancel so many plans...oh wait, my families rate more than doubled, maybe that's how.

  • Report this Comment On December 17, 2013, at 7:44 PM, FuturewwIIIvet wrote:

    I meant to write "my family's"...I really can write.

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Sean Williams

A Fool since 2010, and a graduate from UC San Diego with a B.A. in Economics, Sean specializes in the healthcare sector and investment planning. You'll often find him writing about Obamacare, marijuana, drug and device development, Social Security, taxes, retirement issues and general macroeconomic topics of interest.

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