By now, I am sure you must have heard the sounds of celebration in the Obama administration. It has outdone its own enrollment estimate by ending the second enrollment with 11 million enrollments. This open enrollment has seen 11.4 million people re-enroll or enroll for the first time with federal and state-run marketplaces.
Before the open enrollment kicked off on November 15, the HHS set a target range of enrollments at 10.3 million to 11.2 million by February 15. Although the final numbers are not yet published, estimates show that the marketplaces have already crossed that range. In fact, a million people signed up for coverage through the marketplaces in the last 10 days of open enrollment.
Although the three-month period ended on Feb 15, some extensions were provided to people who had initiated but not yet completed their applications in the system. The extension expired on February 22. Some people experienced long wait times for call centers and technical challenges in the last few days due to overload. Other than that, it was a pretty smooth sail for the exchanges this time around.
Out of the 11.4 million enrollments, 8.6 million came from the federal marketplace www.healthcare.gov, which is being used by 37 states. The remaining 13 states and DC managed 2.8 million enrollments, a pretty strong number for the state-run marketplaces. Although the administration did not delve into the details of re-enrollees and first time enrollees, the ratio should be somewhere around 60-40. However, a noteworthy point here is that not all enrollees have paid their first premium, and since that is necessary for qualifying as ‘enrolled’ with the system, it is likely that the number will come down in the next couple of months. A similar trend was noticed last year, when the initial tally was of 8 million enrollments, but these gradually fell down to below 7 million due to policy lapse and switching of health policies. The cancellation of health insurance due to citizenship and other legal matters was another blow to the enrollment numbers.
Since a similar trend could surface this year too, HHS Secretary Sylvia Burwell is thinking of reopening the enrollment period in the tax filing season of April. The administration expects that about 6 million people will learn that they owe penalties while filing taxes and a high percentage of these people might want to buy health insurance instead of paying penalties. This should be announced in a few weeks. Until then, some states, such as Washington, have already extended their enrollment deadline until the end of April. In 28 states, extensions have been provided to only those people who are not applying for subsidies.
However, amid revelry and a positive outlook resulting from 11.4 million enrollments, the administration and states still need to think that they are far from their goal of a fully insured America. By 2019, there will be at least 30 million uninsured in the country, especially in the 18-34 age range which is choosing to stay away from health insurance due to high costs. There still exists a Medicaid coverage gap that is trapping 5 million people in states, which decided not to expand Medicaid. The SHOP (small business exchange) needs some attention from the administration, as most small businesses are not interested in engaging with the marketplace, choosing instead to offer pay raises to employees who are using the federal marketplace for insurance.
The doctor-patient ratio and the coverage network is another area that needs focus. In the high competition market, several health plans are trying to stay profitable by cutting hospital and physician networks. Couple that with the shortage of primary care physicians and you could have a pretty big issue with appointment availability, etc.
It is clear that other than getting stellar enrollment numbers on the exchange marketplaces, there is a lot that the Obama administration needs to do to retain the ACA momentum. Between this and the looming Supreme Court decision, the future definitely looks challenging.