What the Insiders Will Be Watching During the ACA’s Second Open Enrollment Period

The Affordable Care Act’s second open enrollment period launches in three days.

The media and U.S. residents are expected to focus on how many people enroll in coverage through the law’s insurance exchanges and Medicaid expansion. That focus could be heightened by HHS’ announcement on Monday that it expects as many as 9.9 million people to have exchange coverage by the conclusion of the second open enrollment period in February 2015.

However, the ACA and the open enrollment period are about more than just numbers. With that in mind, California Healthline spoke with several insiders to find out what other issues they’ll be paying attention to during the second enrollment period.

Confused Consumers

The primary concern for nearly all of the experts California Healthline spoke with is ill-informed consumers.

The Kaiser Family Foundation’s most recent tracking survey multiplied those concerns. The survey found that as of late last month nearly nine in 10 uninsured individuals were not aware that the open enrollment period launches on Nov. 15. The survey also found that two-thirds of uninsured respondents said they know “only a little” or “nothing at all” about the ACA’s insurance exchanges and more than half said they did know that they might qualify for financial assistance to purchase exchange coverage.

That gap in knowledge is the “top concern” for Families USA Founding Executive Director Ron Pollack. He’s worried that many uninsured residents “are unaware that they can get help that did not exist before,” specifically in the form of subsidies. As a result, Pollack said “the most important thing that needs to happen in the second enrollment period is education.”

Enroll America Senior Policy Analyst Zachary Baron agreed. He said, “When people know more information [about the ACA], they’re more likely to enroll.” Specifically, Enroll America data show individuals were twice as likely to sign up for coverage if they had help from an assister, often in the form of an ACA navigator, Baron pointed out.

However, there are “fewer resources” in the second enrollment period for such navigators, according to Stan Dorn, a senior fellow in the Health Policy Center at the Urban Institute. He said “it makes a huge difference when somebody who understands the system can sit down and fill out the paperwork for you,” adding that although such helpers are a “basic function” of the ACA, they are “not adequately funded.”

Auto-Enrollment

The lack of knowledge about health insurance could also be a problem for people who already have coverage, particularly those who purchased it during the first open enrollment period.

Dorn noted that most “people tend to stay with the same plan once they get signed up.” While that is “typical human behavior,” it “may not serve people very well come January 2015,” he added.

Current exchange enrollees will be automatically re-enrolled in their current plan for 2015 if they don’t act on their own by Dec. 15. While auto-enrollment might not be a problem for many enrollees, anyone whose financial circumstances changed since signing up could face higher premiums or smaller subsidies in 2015. In both cases, that’s more spending out of pocket.

Many U.S. residents will see their costs go up, “and a lot of people won’t understand why,” Dorn noted. He said he wondered whether those people might drop their coverage as a result, adding that “it could be too late” for people to switch plans once they realize they are paying more out of pocket.

Pollack said Families USA will be working to ensure that current exchange enrollees “go back to the website … and check that the plan that they previously enrolled in is still the best choice for them.” He added, “We want to make sure this large group of people make purchases that are in their best interest.”

The Shorter Enrollment Period

The second enrollment period runs from Nov. 15, 2014, to Feb. 15, 2015. That three-month period is half the length of the initial enrollment period, and that shorter stint will create “a bit more of a challenge,” according to Baron.

Dorn said he is “worried about the shorter enrollment period for lots of reasons,” timing being chief among them. He noted that the holiday season is when “consumer credit balances get most overextended,” meaning that it’s “not a very good time to sell health insurance.”

However, Dorn said that there are “reasonable prospects” that enrollment will pick up in “the latter part of January, the first part of February.”

Further, some of the experts California Healthline spoke to noted that enrollment advocates will have twice the people to attend to in half the time. That’s because their focus will not only be on enrolling new individuals in coverage but also on renewing coverage. According to Dorn, it as if “you’re pouring new water into the bucket, but there is a hole in the bottom of the bucket that’s leaking water.”

Website Complications

Meanwhile, several experts said they will be watching to see how well HealthCare.gov performs.

In the first few months of the initial open enrollment period, HealthCare.gov was awash with technical errors that prevented many U.S. residents from shopping for or enrolling in plans. The site recovered well enough for millions of consumers to purchase coverage, exceeding CBO’s expectations.

Entering the second open enrollment, federal officials have assured insurers and consumers that those technical issues are a thing of the past.

However, recent reports indicate that issues with HealthCare.gov mean insurers aren’t aware when consumers who signed up for coverage during the initial enrollment period have selected a new plan. As a result, some consumers could be enrolled in — and charged for — two separate plans.

And if any problems do crop up, federal officials will have less time to address them.

A Couple Other Concerns

Other experts said they will have their eyes on different issues over the next few months. Katherine Hempstead, a team director and senior program officer at Robert Wood Johnson Foundation, said she’ll be watching whether enrollees from the first enrollment period “trade up or down” in their 2015 plans. “I think it’s possible that people could look at getting more comprehensive coverage,” she said, adding, “What I don’t know is how satisfied people are with coverage they purchased in the first year.”

Hempstead said she will also watch out for “migration” between the small-group market into the small-business exchange, which she said could “end up being pretty significant.” She said, “I’ve talked to small-business people all over the place that are looking at moving over to the small-business exchange.”

A ‘Long Shakedown Cruise’

Although the ACA faces a number of challenges during the second enrollment period, that’s par for the course, at least according to the experts California Healthline spoke to.

Dorn said any complex program like the ACA “takes a long time for it to get up and running effectively.” He added, “It’s going to be a long shakedown cruise … and there will surely continue to be problems.” The ACA “won’t be smooth for, my guess is, five or six years, but the amazing thing is how much good the law has already done,” Dorn concluded.

Around the nation

Here’s a look at what else is making news on the road to reform.

The man uncovering the dirt. BloombergPolitics profiles Rich Weinstein, an investment adviser who uncovered a months-old video of ACA architect Jonathan Gruber discussing the “lack of transparency” in crafting the law.

States’ turn. While there has much ballyhoo about what federal officials have been doing to make sure HealthCare.gov is in working order come Wednesday, the New York Times Abby Goodnough digs into preparations for state-run exchanges.

Upon further review. The Louisville Courier-Journal reports that Kentucky will hire several consultants to determine the costs and benefits of the ACA in the state after its first full year of operation. 

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