HHS Predicts Moderate ACA Enrollment Growth by End of 2016

On Thursday, the Obama administration said it estimates that about 10 million U.S. residents will be enrolled in health coverage purchased through the Affordable Care Act's insurance exchanges by the end of 2016, about 900,000 more than are expected to be enrolled in exchange coverage by the end of this year, The Hill reports (Sullivan, The Hill, 10/15).

Background

About 9.9 million U.S. residents are currently enrolled in exchange plans. Administration officials expect enrollment to drop to about 9.1 million by the end of 2015 (Pear, New York Times, 10/15). Exchange enrollees might drop or lose coverage because:

They are confused about enrollment or premium payment requirements;

• Their incomes decreased;
• They lost their jobs or acquired a job that offers health coverage benefits;
• They realized they could not afford coverage after they enrolled; or
• The subsidies they received to help them purchase exchange coverage under the ACA were cut back or eliminated because the federal government could not verify their incomes or determined their incomes exceeded certain thresholds for the subsidies (California Healthline, 10/13).

HHS Predictions

HHS Secretary Sylvia Mathews Burwell said that she expects between 11 million and 14.1 million U.S. residents to enroll in exchange plans during the upcoming open enrollment period but that some of those individuals will gain coverage elsewhere or fail to pay their premiums.

According to HHS' estimates, those who enroll in exchange plans during the upcoming enrollment period will include:

• 7.3 million to 8.8 million individuals who will likely re-enroll in exchange coverage;
• 2.8 million to 3.9 million uninsured individuals who are expected to enroll in exchange coverage; and
• 900,000 to 1.5 million who will switch to exchange coverage from other health plans (New York Times, 10/15).

According to The Hill, HHS' goal is to have more than 25% of the 10.5 million uninsured U.S. residents enroll in exchange coverage during the ACA's upcoming open enrollment period, which will begin on Nov. 1.

HHS Prediction Lower Than CBO Estimate

The Congressional Budget Office earlier this year predicted that more than 20 million U.S. residents will be enrolled in exchange coverage in 2016, The Hill reports.

According to the administration, CBO's prediction was based on an assumption that more U.S. residents would switch to exchange coverage from employer-sponsored plans. However, such a shift has not occurred.

Reaching Remaining Uninsured Could Be Difficult

Meanwhile, the administration has noted it could be difficult to reach those who remain uninsured, as those who were already inclined to enroll in exchange coverage or were easiest to reach have already signed up for exchange plans. HHS Assistant Secretary of Planning and Evaluation Richard Frank said, "[W]e are seeing a much longer path" to enroll those who remain uninsured (The Hill, 10/15).

Further, Burwell noted that "the remaining uninsured have a lot of concerns about whether they can afford coverage," even when accounting for the ACA's subsidies (New York Times, 10/15).

Still, Burwell said, "While our audiences may be harder to reach, we're working smarter to reach them." 

For example, HHS is:

• Advertising about in-person enrollment assistance;
• Launching more localized campaigns; and
• Sending enrollment reminders at effective times (The Hill, 10/15).

Administration officials also said HHS plans to make several improvements to HealthCare.gov, such as adding an "Under 30" tab that will provide additional coverage information to individuals ages 30 and younger (Carey, Kaiser Health News, 10/15). According to Politico, about half of the remaining uninsured U.S. residents who are eligible to enroll in exchange coverage are between ages 18 and 34.

In addition, officials say the ACA's individual mandate penalties could play a larger role during the upcoming open enrollment period (Pradhan, Politico, 10/15). The penalty this year will increase from $325 or 2% of an individual's income to $695 or 2.5% of income (Muchmore, Modern Healthcare, 10/15).