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Obama administration predicts significantly lower health-care enrollment Obama administration predicts significantly lower health-care enrollment
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The Obama administration announced Monday that it expects the number of people who will have gained health coverage in the next year through the Affordable Care Act’s insurance marketplaces to be significantly lower than previous government predictions. The Obama administration predicted Monday that the number of people with health coverage through the Affordable Care Act’s insurance marketplaces will be significantly lower by the end of next year than previous government estimates.
Health and Human Services Secretary Sylvia Matthews Burwell said 9 million to 9.9 million Americans — as much as 30 percent below other estimates— will have insurance by the end of 2015 through fledgling federal and state insurance exchanges intended for people who cannot get affordable coverage through a job. Health and Human Services Secretary Sylvia Mathews Burwell announced that, by the end of 2015, 9 million to 9.9 million Americans probably will be in health plans sold through the federal and state insurance exchanges created under the health-care law. The administration’s expectations are as much as roughly 30 percent beneath the most recent prediction of the Congressional Budget Office — that 13 million people will have health coverage through these exchanges next year.
The figures mark the first time that the administration has made public its view of how popular the marketplaces’ health plans, which began to provide coverage in January, will prove in their second year. They are more cautious than estimates last spring by the Congressional Budget Office, which predicted that 13 million people would have health coverage through these insurance exchanges in 2015. The discrepancy revives questions about the pace of progress on a central mission of the law — to widen Americans’ access to affordable insurance — and how well the administration and its allies will be able to keep customers who already have bought marketplace health plans and attract new ones.
Burwell said early Monday afternoon that HHS's figures are based on a department analysis that took into account how quickly people have tended to be drawn to other kinds of public health insurance programs when they were new, combined with predictions of how many people who bought health plans through the exchanges this year will keep them. The new figures mark the first time that the administration has shared publicly its view of how popular the marketplaces’ health plans, which began to provide coverage in January, will prove after their first two years. The figures are based on an analysis by HHS researchers that considered how long it took Americans to flow into other public health insurance programs when they were new, how many people will stay in health plans sold through insurance exchanges and how many uninsured people will gravitate to the new marketplaces.
At a briefing for reporters earlier in the day, other HHS officials said that, as of mid-October, 7.1 million people were paying customers of health plans they had bought through the marketplaces, a slight decrease from 8 million customers just after the first, shaky enrollment period ended early last spring. The decrease is, in part, because not all customers have continued to pay their monthly insurance premiums — and because the government has dropped 112,000 immigrants who did not prove that they were eligible. HHS officials also said Monday that of the 8 million people who bought health plans by this past spring for the first year of coverage under the law, 7.1 million remained in them as of mid-October. Of those who left, some had stopped paying their monthly insurance premiums, and 112,000 were immigrants dropped by the government because they had not proved that they were eligible.
Burwell disclosed the HHS estimates five days before the second open enrollment season begins on Saturday. The administration’s enrollment expectations appeared five days before the start of the second sign-up period through the federal insurance exchange being used in about three dozen states and through separate state-run exchanges. The figures also emerged as the health-care law — enacted in 2010 as a crowning domestic achievement of Obama’s presidency — is facing new political and legal peril.
The administration is touting various improvements they have made to the federal online marketplace, HealthCare.gov, in an attempt to avert a repeat of massive technical problems that frustrated customers — and created political embarrassment for President Obama — when the exchange first opened for people to buy health plans in October of last year. Congressional Republicans, who won a Senate majority in the midterm elections last week, have vowed to continue their efforts to repeal the law, or at least make dents in pieces of it.
The lower estimates also emerge as the health-care law, enacted in 2010 as a crowning domestic achievement of Obama’s presidency, is facing new political and legal peril. Congressional Republicans, who won a Senate majority in the midterm elections last week, have vowed to continue their efforts to try to destroy the law, or at least make dents in pieces of it. Meanwhile, the Supreme Court on Friday said it would review the legality of a linchpin of the law: the government subsidies that are helping more than four in five people who have gotten insured so far through the federal exchange to afford their health plans. And the Supreme Court has just announced that it will review the legality of a linchpin of the law: government subsidies that are helping more than four in five people who have gotten insured through the federal exchange to afford their health plans.
In explaining the HHS predictions, health officials said their analysis suggests that congressional budget analysts were too optimistic in assuming that enrollment in the marketplaces’ health plans would reach its final level within the first three years. The officials said the “ramp up” was more likely to take four or five years. Exactly what the administration’s enrollment expectations will mean about the law’s ultimate success is a matter of debate. If too few people sign up in the long run, health plans could drop out of the program or insurance prices could rise.
The congressional budget analysts predict that 25 million people will have insurance through the federal and state marketplaces by 2015. Health officials declined to say whether they believe that many eventually will sign up, saying they have not done that analysis. The HHS officials, who briefed reporters before the secretary’s announcement on the condition of anonymity, said the differing predictions largely reflect varying assumptions about timing. They expect that enrollment in health plans under the law probably will phase in over four or five years — more gradually than the three-year phase-in assumed by congressional budget analysts.
The health officials also forecast that slightly more than eight in 10 people who got coverage this year through the exchanges will renew it for 2015. That means that 5.3 million of the current 7.1 million enrolled will keep their coverage. The officials said they do not expect many of them to become uninsured. Some, they said, will be able to find coverage from an employer, still the way most Americans get health insurances. Others, they said, will find their incomes dropping enough that they begin to qualify for Medicaid, a public insurance program that has expanded under the health-care law in about half the states. By 2017, the congressional budget analysts said in their most recent estimates, which were issued in April, the exchanges will have reached their full enrollment: 25 million. HHS officials declined to discuss whether the program eventually will attract that number.
The HHS forecast means that, compared with the first sign-up period, the administration is expecting fewer people to buy coverage for the first time during the impending open enrollment, which runs from Nov. 15 to Feb. 15. Some health policy specialists speculated that administration officials had made a strategic decision to issue a relatively low prediction to increase the chances that the sign-up this time will surpass it. Meanwhile, Republican foes of the health-care law portrayed the administration’s lower number as a sign that consumers have realized that health plans sold through the marketplaces are “not a good deal for them,” as Sen. John Barrasso (R-Wyo.), an outspoken critic, put it.
Given that the analysis anticipates 5.9 million customers will renew their coverage, the prediction of up to 9.9 million people covered through the exchanges in 2015 suggests that the administration expects no more than 4 million first-time customers during this second round — compared with the 8 million by last spring. Other health policy specialists said the significance of the lower figures will not become clear until the sign-up period, from Nov. 15 to Feb. 15, has ended. On one hand, people most eager for insurance may already have signed up.
“We are moving to a group that might be harder to reach,” Burwell said during an appearance at the Center for American Progress. On the other, people may be motivated to get coverage because the law requires it of most Americans and because a financial penalty for remaining uninsured will increase next year.
“There is still a lot of mystery,” said Larry Levitt, senior vice president of the Kaiser Family Foundation, a health policy organization.
The insurance exchanges are one of two paths the law envisioned to help people who cannot get affordable health coverage through a job. The other path is Medicaid, for people with lower incomes; about half the states have expanded their Medicaid programs under the law.
Burwell said the administration’s enrollment target for new and returning customers would be 9.1 million for 2015.
The health officials said they are forecasting that slightly more than eight in 10 people who got coverage this year through the exchanges will renew it. That means that 5.9 million of the 7.1 million current customers will keep their health plan or choose another one through an exchange.
Of those who leave, officials said they do not expect many to become uninsured. Some, they said, will be able to find insurance through an employer, still the way that most Americans get health insurance. Others, they said, will find their incomes dropping enough that they begin to qualify for Medicaid.
HHS officials played down the fact that their analysis suggests that fewer people will buy a health plan for the first time during the second round than did so in the first.
Because the analysis anticipates that 5.9 million customers will renew coverage and that up to 9.9 million will be covered by the end of 2015, that means the administration is expecting no more than 4 million first-time customers during this second enrollment period — half as many as last time.
Burwell hinted at the challenges at a Washington event to draw attention to the start of the second enrollment period and promote improvements to the federal online marketplace, HealthCare.gov. “We are moving to a group,” she said, “that might be harder to reach.”
Jason Millman contributed to this report.
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