Welcome to Health Reform Watch, Sarah Kliff’s regular look at how the Affordable Care Act is changing the American health-care system — and being changed by it. You can reach Sarah with questions, comments and suggestions here. Check back every Monday, Wednesday and Friday afternoon for the latest edition, or sign up here to receive it straight from your inbox. Read previous columns here.

The Obama administration has beaten a monthly health insurance enrollment target for the first time, according to data released Wednesday showing that more than 1.14 million people signed up for health plans in January in the new insurance marketplace.



The latest enrollment data from the Obama administration show that 3.3 million people have signed up for private health insurance through federal and state insurance exchanges created under the Affordable Care Act. This figure represents all enrollment from Oct. 1 through Feb. 1. It includes both people who have and have not paid their first month's premium. Of those people, 1,146,100 selected their health insurance plans in January, meaning there was a 53 percent increase enrollment last month alone.

This makes January the first month that the Obama administration has beaten an enrollment target. Back in September, way before HealthCare.gov's botched launch, the Centers for Medicare and Medicaid Services projected that 1,059,900 people would sign up for private health insurance in January.

However, the Obama administration still falls short of projected, cumulative enrollment by 1 million people, largely due to the anemic sign-ups in October and November.

This is also a drop-off from December's enrollment number of 1.8 million sign-ups, which both the Obama administration and health policy experts expected. They predicted a rush of enrollments in December, for people who wanted to get covered at the start of the year. They also foresee another surge of enrollment in March, the last month when people can sign up for coverage through the exchange.

The new enrollment figures also show a slight increase in the number of young adults signing up for coverage. Young adults between 18 and 35 made up 27 percent of the enrollees in January, compared to 24 percent of those signing up from October through December.

Taken together, this means that 25 percent of those who have enrolled are the young adults that the Obama administration thinks will be healthier, and thus hold down insurance premiums in the exchanges. This is still below the 40 percent target that the Obama administration had previously set for overall exchange enrollment, although the hope, on their part, is that the 25 percent number continues to inch up in February and March.

The balance of people selecting coverage is shifting slightly toward the HealthCare.gov site rather than the 14 state-based exchanges, most of which had more successful launches than the federal Web site.

The biggest takeaway here, probably, is that Obamacare is starting to look more and more like the law that the White House had hoped to launch -- not the one where technical glitches made it nearly impossible for shoppers to get in the door.

KLIFF NOTES: Top health policy reads from around the Web.

Small businesses get Obamacare relief -- but aren't sure they'll use it. "Small and midsize businesses stand to benefit the most from the latest delay in the health law's employer insurance requirement. But farm co-owner Laura Pedersen doesn't plan to take advantage of it. The Seneca Castle, N.Y., proprietor of a produce and grain farm last year rearranged her employees' schedules and workloads to keep the farm's full-time staff below 50 workers. Her goal was to avoid having to start providing insurance or pay a penalty in 2015 under the Affordable Care Act." Sarah E. Needleman and Rhonda Colvin in the Wall Street Journal.

For HealthCare.gov work, CGI employees are still in hot demand. "After denigrating the work of CGI and replacing it as the largest contractor on the federal health care website, the Obama administration is negotiating with the company to extend its work on the project for a few months. And the new prime contractor, Accenture, is trying to recruit and hire CGI employees to work under its supervision." Robert Pear and Ian Austen in the New York Times.

What did Congress mean when they drafted Obamacare's subsidy language? Let's ask congressional staff! "Two staff-level sources directly involved in drafting the law told TPM that no one intended to block subsidies from being administered through the federal website. Instead, they blame the poorly worded phrase on which conservative have based their case on the unusual legislative process through which Obamacare became law. "I don't even understand how the question is being asked," one source said, "except you could go through the law and find all sorts of issues that probably could have been drafted clearer. I think the opponents of health reform are just scanning for inconsistencies and poorly drafted language and trying to exploit them."" Dylan Scott in Talking Points Memo.