By Paul Demko, Crain News Service
WASHINGTON (Nov. 11, 2014) — The Obama administration is significantly reducing expectations for the open-enrollment period for the Patient Protection and Affordable Care Act (ACA) that begins Nov. 15.
Health and Human Services (HHS) expects 9 million to 9.9 million individuals to obtain coverage through the state and federal exchange for 2015, according to a memo released by the agency Nov. 10.
That's far short of the 13 million cumulative enrollment projected by the Congressional Budget Office (CBO) for 2015. HHS anticipates that the vast majority of the new enrollees — 75 percent to 80 percent — will be individuals who are currently uninsured.
HHS' memo attributes the lower projection to a slower transformation of the health insurance marketplace than anticipated by the CBO, which predicted that enrollment through the exchanges would reach 25 million individuals in 2016. In particular, the federal agency suggests that the movement away from employer-sponsored coverage and the non-exchange individual market will be slower than anticipated.
“Thus, there is considerable uncertainty that a large shift will occur in the next two years,” the memo states. “This contributes to an analysis that the ramp up to 25 million will take more than three years.”
HHS also slightly reduced the number of individuals who received coverage through the state and federal exchanges for this year. The agency now estimates that 7.1 million individuals have obtained coverage through the government-run marketplace, down from the previous estimate of 7.3 million beneficiaries. In addition, HHS projected 83 percent of those customers — or 5.9 million — would retain coverage for 2015.
The federal agency estimates that there are currently 32 million individuals without insurance coverage, a reduction of more than 25 percent since the exchanges opened for business in October of last year. That amounts to 10.3 million fewer individuals lacking coverage. Of the remaining uninsured, approximately 15 million are eligible to purchase a health plan through the exchanges. In addition, there are 8 million to 12 million potential exchange customers who currently have individuals plans purchased outside the government marketplaces.
Jon Kingsdale, who was the founding executive director of the Commonwealth Health Insurance Connector Authority in Massachusetts, said the Obama administration needs an effective “ground game” to bolster the long-term viability of the federal healthcare law. “The number one metric for building support for the ACA is enrollment,” said Mr. Kingsdale, who is now director of Wakely Consulting Group's Boston office. “They're going to need to build enrollment if they're going to build political support.”
The reduction in enrollment projections is the latest setback for the Obama administration in recent days. Last week, Republicans won control of both chambers of Congress, promising to roll-back the ACA. On Nov. 7, the Supreme Court announced that it would take up King v. Burwell, a lawsuit that has the potential to cripple the federal healthcare law by invalidating premium subsidies in the 36 states that have not developed their own exchanges.
Republicans were quick to pounce on the bad news for Obamacare.
“Once again, the Department of Health and Human Services is lowering expectations ahead of Obamacare's open enrollment period, a tactic that has become par for the course for this administration,” said Rep. Darrell Issa, R-Calif., chairman of the Committee on Oversight and Government Reform, in a statement. “The prospect of lower enrollment figures should come as no surprise given Obamacare's troubled track record over the last year.”
HHS Secretary Sylvia Mathews Burwell, speaking Nov. 10 at the Center for American Progress, downplayed the significance of the Supreme Court's action. “The most important thing for consumers to know is that nothing has changed,” Ms. Burwell said. “The tax credits that they'll be signing up for…will be continuing.”
Ms. Burwell also stressed that this is actually the first full open-enrollment period because it's the first time that re-enrollments will be part of the process. “Any time you do things for the first time, it's hard and you worry,” Ms. Burwell said. “We are going to have things that will go wrong.”
In addition, Ms. Burwell argued that the success of the federal healthcare law should be measured by the 25 percent reduction in the level of uninsured, whether that's through exchange plans, Medicaid expansion or other means.
“That's the facts,” Ms. Burwell said. “As we think about the go-forward, that's the conversation we want to have.”
This report appeared on the website of Crain's Modern Healthcare magazine, a Chicago-based sister publication of Tire Business.