With open enrollment for health insurance coverage under the Affordable Care Act beginning Saturday, expectations are that by the end of 2015 less than 10 million will be signed up, much lower than the 13 million projected. The new estimate for participation in Obamacare comes from the Health and Human Services Department (HHS), and is as much as 30 percent lower than the Congressional Budget Office’s (CBO) initial predictions.
CBO had forecast that 25 million people would be consistently enrolled in Affordable Care Act (ACA) health insurance coverage by 2017, but HHS now says it appears that it will take quite a bit longer to reach that target. Currently about 7.1 million are enrolled, and HHS assumes that 83 percent of those will renew coverage for 2015.
HHS said that recent data shows the lower enrollment is due to a slower shift to the government-run plans from employer-sponsored health insurance, a trend that is expected to continue as Saturday’s open period begins. The department said that it thinks that most of the new enrollment in ACA plans for 2015 will be from the uninsured, rather than insured people switching coverage.
The 7.1 million insured is what remains in Obamacare after 8 million people initially bought into the plans last spring. Some stopped paying their monthly premiums and about 112,000 others were dropped because they were immigrants who could not prove that they were eligible.
The future of Obamacare is facing new dangers with the election of a Republican Senate majority last week. Republicans have vowed to continue efforts to repeal the law. Lower-than-expected enrollment could also jeopardize the ACA marketplace, as some health plans may drop out or raise prices due to low participation.
There is also the issue of technical problems that plagued health insurance enrollees last year. The Obama administration has expressed confidence that those problems will not recur this year, but government contractors and federal health officials are making contingency plans against the possibility that the enrollment website will prove less reliable than predicted by the administration. Officials are publicizing that the online insurance applications will be easier to use and that parts of the problematic computer system have been rebuilt. New federal managers are also in charge.
The stakes are high that the health insurance enrollment process work smoothly this year. Internal documents show that elaborate backup plans are in place, one of which describes a system known as “throttling” that can be implemented if too many people try to use HealthCare.gov at the same time. Throttling could send some groups of people into online “waiting rooms” in separate parts of the system that allow queues for specific parts of the enrollment process rather than the one huge waiting line such as the one that frustrated consumers last spring.
Testing is ongoing for the small-business exchange (SHOP), which was not ready for sign ups last year. HHS’ Center for Medicare and Medicaid Services (CMS), which is the agency that oversees Healthcare.gov, says SHOP should be tested enough by then to be functional, although testing will continue. Testing also continues to try to ensure that the computer system is safe from hackers, after the Government Accountability Office joined Congressional Republicans in warning that the system does not have strong enough privacy protection. Department of Homeland Security computer experts are trying to hack into HealthCare.gov at least once a day to determine the system’s vulnerability.
In addition to lower enrollment expectations, the ACA health insurance sign-up window that begins Saturday will be open for a shorter period than the first one. This time open enrollment is only half as long, running from Nov. 15 to Feb. 15. Enrollees who with their coverage to start at the first of the year need to sign up by Dec. 15.
By Beth A. Balen