After Obamacare surge, officials consider special sign-ups

State and federal governments saw a huge, last-minute surge in Obamacare sign-ups ahead of last Sunday's deadline, boosting total enrollment that surpassed the administration's expectations.

Of the 11.4 million Americans who have newly enrolled or re-enrolled in private health coverage through the Affordable Care Act (ACA) this year, 8.6 million signed up through the federal marketplace and about 2.8 million through state-based exchanges, federal officials said Wednesday. The Department of Health and Human Services had predicted up to 11.2 million enrollees for 2015.

"In the final day, more new consumers signed up for health coverage than on any other day this open enrollment or last.," HHS Secretary Sylvia Burwell said in a statement.

Many consumers in the 37 states using HealthCare.gov enrolled close to the Feb. 15 deadline, pushing up wait times at the federal call center. The average wait time in the final week was 22 minutes and 41 seconds, compared with 8 minutes and 16 seconds for the entire enrollment period.

"It was a blowout weekend for us," said Kevin Counihan, CEO of Healthcare.gov.

Officials in states running their own exchanges said during a conference call hosted by Families USA that they experienced similar surges in the final days of open enrollment.

For example, in Kentucky -- where a total of 27,000 people newly enrolled in qualified health plans and about 75,000 re-enrolled -- 6,000 enrolled last week, three times the typical 2,000 a week. And in Washington state -- where a total of 160,000 residents enrolled or re-enrolled -- 20,000 signed up in the last week, said Richard K. Onizuka, chief executive officer of the Washington Health Benefit Exchange.

On Monday, federal officials extended the deadline a week, until next Sunday, for those who couldn't enroll in ACA insurance plans on the Healthcare.gov site over the weekend because of computer glitches or long waits. They will still be able to get coverage that begins March 1. Fewer than 150,000 people were still in line on hold with the call center when the deadline hit and are able to sign up before this Sunday. HHS didn't disclose the number that couldn't complete their enrollment because of technical issues.

Most states have also extended deadlines for some consumers for the same reasons or because of weather problems, although those deadlines vary and in some cases coverage begins after March 1.

Now many officials are considering a special enrollment period for Americans who discover at tax time they'll face a penalty for not having insurance. Burwell said federal officials will make a decision in the next two weeks. Minnesota announced Wednesday that it would extend its deadline through tax season; Washington state announced it would do so earlier this week.

Exchange officials from Kentucky, New York and California also said they are considering a similar special enrollment period for residents who discover they face a fee.

Under the ACA, the fee for not having coverage in 2014 is $95 a person or 1% of annual household income, whichever is higher. The fee for not having coverage in 2015 is $325 per person or 2% of household income, whichever is greater.

Peter Lee, executive director of Covered California, said many people in his state signed up for coverage after visiting with tax professionals and realizing they would face that penalty for the first time.

"This is a teachable moment," Lee said. "This is the first time in our history that health care and taxes are totally intertwined."

Already, Americans with "qualifying life events" such as getting married or divorced or giving birth are eligible for a special enrollment period that lasts 60 days after the event.

The national non-profit Young Invincibles, which represents the interests of 18- to 34-year-olds, is lobbying to add pregnancy to the list of qualifying life events. Although the ACA requires plans to include maternity care, some women don't have the coverage because they are on transitional or grandfathered insurance plans that don't comply with the ACA, or are dependents on their parents' employer-sponsored plans. Maternity care and delivery can cost an estimated $10,000-$20,000, without medical complications.

Burwell said HHS has not included pregnancy as a qualifying life event because it has based its approach on that used by insurance companies. But she said the agency is happy to consider the issue raised by Young Invincibles and other groups.

On a press call hosted by HHS Wednesday, Robert Mandler Jr., who runs a bread distribution business in Florida, told his personal Obamacare story. He said he was opposed to the ACA and was just going to pay the penalty for not having insurance last year. But after noticing a problem with his tonsils in late 2013, he decided to sign up.

He made an appointment to see a doctor on Jan. 2 of last year and learned he had stage 4 cancer. After about $200,000 in treatment costs -- all but $3,500 of it covered by his $118-a-month subsidized insurance -- he's now cancer-free.

"Without my Marketplace insurance, I would have gone bankrupt or died," Mandler said. "I know that health insurance saved my life and is giving me a new life."