When Democrats were drafting the proposals that created the Affordable Care Act, from 2008 through 2009, some wanted to have the government offer a Medicare-like buy-in plan to every American, or even to shift to a government-run, universal health care system that would eliminate private health insurance.

Other Democrats, who wanted to keep private health insurers in the system, promoted an idea with some support from America’s Health Insurance Plans: Creating a web-based “Travelocity for health insurance,” so consumers could shop for solid health coverage from private insurers on an apples-to-apples basis, and use federal subsidies to pay for the coverage they bought.

The result was a family of ACA public health insurance exchange programs.

Eleven states and the District of Columbia run their own exchange programs.

CMS set up HealthCare.gov to act as the health insurance supermarket manager for states that were unable or unwilling to handle all of the job themselves. HealthCare.gov provides ACA exchange plan enrollment and account administration services for residents of 39 states.

HealthCare.gov managers report “plan selection” totals, rather than sales figures, because they record a sale only when a consumer has “effectuated” coverage by making a premium payment. Many of the consumers who have purchased HealthCare.gov still have time to make their first payments. In the past, about 85% of the people who have selected HealthCare.gov plans have effectuated the coverage.

Why Does HealthCare.gov Have an ‘Open Enrollment Period’?

Consumers can buy individual major medical coverage during the open enrollment period” without having any particular reason to be shopping for coverage.

Outside of that period, consumers must show they have moved, lost a job, or gone through some other life changes that the government classifies as a good excuse to be shopping for coverage.

Regulators, exchange program managers and insurers developed the open enrollment period system to try to persuade young, healthy people to pay for coverage even when they feel great.

The system is supposed to make healthy consumers conscious of the possibility that they could end up facing big medical bills if they need medical care outside of the open enrollment period and have no way to buy major medical coverage.

One constraint on the system is that the drafters of the ACA left short-term medical insurance outside of the ban on medical underwriting, and out of the open enrollment period framework. Short-term medical insurance issuers can use medical underwriting, but, if people are healthy enough to buy short-term medical insurance, they can buy it at any time of the year.