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Potential Outcomes Of The ACA’S Third Enrollment Period And Their Implications

Officials are hoping for strong enrollment during President Obama’s last year at the helm of his signature health law, but the final outcome is no less certain than it was three months ago when the third open enrollment period started.

The stakes are high this year in light of the upcoming presidential election: GOP members hope that a Republican in the White House could mean the end of the ACA, while Democrats want to extend — or at least maintain — the coverage gains made under the law.

The enrollment outcome and its implications for the ACA likely will serve as political fodder when the yet-to-be-determined presidential nominees approach the final stretch of the election year. With that in mind, here are three potential outcomes of this year’s enrollment period that could sway the law’s future.

Missing the Mark

HHS’ annual enrollment predictions have been getting smaller and smaller, which has helped the administration surpass single enrollment period expectations.

But compared with projections from when the ACA first passed, 2016 enrollment will be millions of people short.

In 2010, CMS projected that about 24.8 million people would be enrolled in coverage by the end of 2016. The Congressional Budget Office estimated about 21 million.

With about three weeks left in the third enrollment period, HHS announced that about 11.3 million people had signed up for coverage through the ACA’s exchanges — far short of those early projections.

At the same time, that number is right on target with HHS’ revised estimate of 9.4 million to 11.4 million enrollees.

Still, HHS could miss even that lower number if this year’s actual enrollment follows last year’s trends. At that time, about 12% of people who signed up for ACA plans never paid their first premium, according Brian Blase, a senior research fellow at George Mason University’s Mercatus Center.

A Young Person’s Game

The ACA typically has struggled to attract young individuals to the exchanges, but that trend could be changing.

CMS officials say that as of early January, about one in four federal exchange consumers was between ages 18 and 34, Ricardo Alonso-Zaldivar writes for AP/Yahoo! News.

Some experts have urged caution about drawing conclusions too soon, Alonso-Zaldivar writes. For example, Caroline Pearson, of Avalere Health, told AP/Yahoo! News that the number of young adults represents only a “modest improvement” from last year.

But administration officials have said they expect a surge of “young procrastinators” to sign up in the days leading to up to the Jan. 31 deadline.

Meanwhile, a recent Gallup poll found that the percentage of uninsured adults:

  • Ages 18 to 25 fell from 23.5% in the fourth quarter of 2013 to 15.9% in Q4 2015; and
  • Ages 26 to 34 fell from 28.2% in Q4 2013 to 20.9% in Q4 2015.

If enrollees continue to trend younger, it could help keep down premiums for subsidized plans in the following year, Alonso-Zaldivar notes.

Sticker Shock

Exchange officials started encouraging consumers to shop around for coverage at the start of the second enrollment period. And the message was no different this time around.

The idea was that consumers who look for new plans could avoid premium increases and find lower-cost options.

But according to research from the Mercatus Center, about 28% of federal exchange consumers auto-renewed coverage last year, while about 50% of state-exchange enrollees did the same.

If that trend continues, a large share of consumers could face higher costs.

Last year, officials announced that premiums for the second-lowest-cost silver plans, which serve as a benchmark for calculating subsidies, would increase by an average of 7.5%. Meanwhile, an Avalere analysis of federal data found that the lowest-cost silver plan would increase by about 13%.

Cynthia Cox, a Kaiser Family Foundation researcher, told Kaiser Health News, “The bottom line is that insurance companies are increasing premiums for what had been the lowest-cost silver plan,” adding, “In many cases, people could save money on their premiums by switching to a new lowest-cost silver plan.”


Scenarios one and three — falling short on enrollment goals and higher premium costs — could serve as a boon for Republicans by substantiating claims that the ACA has failed to deliver on its promises.

But under the second scenario, Obama — and other Democrats who support the law – might leave the ACA on steadier footing and with additional backers in a time when attacks against it are frequent.

Around the Nation

Here’s what else is happening on the road to reform.

Health care for all. Democratic presidential candidate Sen. Bernie Sanders (I-Vt.) has released a plan to transition the U.S. to a universal health care system that would create several new taxes to pay for the expanded coverage, Peter Sullivan reports for The Hill.

Medicaid money. President Obama’s fiscal year 2017 budget proposal will call on Congress to extend the federal government’s 100% funding share of Medicaid expansion costs for the first three years of a state’s expansion, regardless of when the expansion begin, Virgil Dickson writes for Modern Healthcare.

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