Blue or red, a majority of states have exceeded their health care sign-up targets under President Barack Obama's law — something that would have been hard to imagine after last fall's botched rollout of insurance markets.
In Tennessee, federal officials say 151,352 people chose health plans in the new insurance marketplace created by President Barack Obama's health care law. That's about double the number that had signed up at the end of February, showing there was a last-minute rush of enrollees in the state.
The federal data shows that many Tennessee residents who have obtained coverage are older, though about 34 percent are under age 35. More than half are women, and 80 percent are getting financial help to pay their monthly premiums.
But the administration's final numbers also expose shortcomings, including subpar enrollment among Hispanics, the nation's largest minority group and also its least insured.
Still, strong state-by-state performance indicates that the health care law is making inroads around the country, even as Republicans insist repealing "Obamacare" will be a winning issue in the fall congressional elections. An Associated Press analysis of the government numbers found that 31 states met or exceeded enrollment targets set by the administration before the insurance exchanges opened. Twenty of those are led by Republican governors, many of whom were hostile to the program.
The Health and Human Services Department said 8 million Americans chose a health plan through the new insurance markets in the first year of the historic health care overhaul. Some 4.8 million more gained coverage through Medicaid and children's insurance programs. A surge in enrollments since March 1 doubled sign-ups in some states, including Texas, Georgia and Florida.
"There is reason to be optimistic about what the law can deliver, both in terms of coverage and affordable insurance options" said Andy Hyman of the nonpartisan Robert Wood Johnson Foundation. "In time, it will become part of the bloodstream of our health care system." Hyman is a senior program officer working to expand coverage.
With Republicans vowing to make the failures of the law a main theme of their midterm election push, the Obama administration will need to convince the public that it has been a success. A recent administration announcement of the 8 million sign-ups failed to move public opinion much, with negative views of the law more common than positive ones. But polls also have found that Americans don't want the law repealed, preferring that Congress work to improve it instead.
The new report didn't include information on how many of the newly enrolled have actually paid their insurance premiums. With grace periods for enrolling extending into mid-April, many who have signed up weren't obligated to pay until this week. A report released Wednesday by House Republicans said 67 percent of people who had signed up through federal marketplaces had paid their first month's premiums as of April 15, far lower than payment rates reported by some individual insurers, which were more in the range of 85 percent or above.
Even though the administration is claiming huge successes, the Congressional Budget Office projects more than 40 million people will still be uninsured this year, and a more complete picture of who's still uninsured won't emerge until next year with the first results from large national surveys.
"Beyond a doubt, the number of uninsured Americans has fallen by millions. Whether it's 5 million or 15 million still isn't clear," said Larry Levitt, an expert on health insurance markets at the nonpartisan Kaiser Family Foundation. "The low enrollment among Latinos is an indication of where challenges still lie: the hard-to-reach groups where more outreach is probably needed."
Other highlights of the report:
Young adults aged 18 to 34, whose premiums are needed to balance the cost of older, sicker enrollees, made up about 28 percent of the total 8 million. Independent analysts have said the mix should be 40 percent young adults. But the administration called the mix sufficient to keep premiums stable.
•More women than men signed up through the exchanges: 54 percent vs. 46 percent.
•It's still not clear how many people who purchased coverage on the new markets already had insurance. The report said of the 5.18 million who applied for financial assistance and selected a plan on the exchanges run by the federal government, 13 percent said they already had coverage.
•Blacks and Asians signed up at higher-than-expected rates. Blacks make up 13.3 percent of those eligible for marketplace coverage, but represented 16.7 percent of those who chose a health plan and disclosed their race. Asians make up 3.3 percent of the eligible pool, but were 7.9 percent of enrollees who volunteered racial information.
•Nearly a third of people who chose a health plan on the federal exchanges didn't report their race or ethnicity, or chose "Other."
The next enrollment period for private health insurance coverage for 2015 under the health law is scheduled to run Nov. 15 through Feb. 15.
"They've had some success," Levitt said, "but they're going to have to do it all over again next year and get more people signed up to succeed."