Even after the botched rollout of Obamacare, the 8 million enrollments gathered under the ACA were a strong sign that the uninsured are interested in getting health insurance under the reformed set of laws. The Obama administration estimated that even after so many missed opportunities, which definitely cost them a good number of enrollments, the enrollments were a bit higher than the earlier target of 7 million. Naturally, with a fully streamlined federal marketplace, this number could have been much higher. The administration is gearing up for maximizing the second open enrollment period by driving uninsured enrollments through a fully functional federal marketplace. However some experts are saying that the uninsured enrollment might not be as high this year.

The first strides made by the law might be hard to sustain, as the law still hasn’t penetrated to that level. In the first stage of the ACA push, the uninsured enrollments came from people who desired health insurance coverage. These people were either suffering from pre-existing medical conditions or were unable to afford better health coverage without the associated subsidies. In simple terms, these uninsured were the low hanging fruits, which the ACA could grab. The remaining uninsured might not be that easy to attract.

Currently, there are approximately 54 million people still uninsured. The 10 million previously uninsured that purchased insurance through one of the channels of ACA did make a dent in this monster number, but there is still a long way to go. While the public view of the law is still negative in some places, there are several other challenges that are preventing the remaining uninsured from enrolling. For instance, a huge chunk of the population is still unaware about the subsidies and provisions provided for families belonging to lower income groups. Between Medicaid expansion and Obamacare subsidies, these low income groups are almost fully covered, but not many are privy to this fact.

Additionally, there are sections of the population who haven’t been able to gain access to the benefits.  For instance, Hispanics have a high rate of uninsured in the population, but they were the ones who were not largely enrolled due to a variety of reasons. People with less education, people living in rural areas, and people disconnected from community groups are also alienated from the workings and the benefits of the law. Lack of Internet, TV or News access is another reason for people not really knowing about the Affordable Care Act. The homeless are another demographic that has a high rate of being uninsured, mainly because they are not aware of the facilities available to them. Other than these people, there are sections that do not want health insurance coverage.

People who have never had health insurance or have been living without it for at least two years are going to be the hardest to insure. As per the numbers available from California, 82 percent of uninsured  have not had health insurance for at least two years, or have never been insured. These people are going to be the hardest to convert.

Other than existing numbers, there is the perennial trend of a rise in the uninsured population of the country. By end of another decade, the CBO estimates that there will be 57 million uninsured in the U.S. Without ACA, this number could go up to 85 million.

Naturally, the presence of ACA is driving the country to a better health insurance system, but the next year might not see so many uninsured lining up to get health insurance off the exchanges. They will make the administration work hard to get the enrollment numbers up. Fortunately, the Obama administration has a plan for reaching these remaining uninsured.

The administration now plans to surmount these challenges in the coming open enrollment period. Other than the regular help available through exchange navigators, the administration is planning to spread information about available financial benefits for the uninsured. More than 50 percent of the people who did not enroll with the ACA thought they wouldn’t be able to afford it, and the administration wants to weed out these issues. In-person application help for specific communities will continue to gain momentum for driving enrollments in high risk, high uninsured rate communities.

Even with these measures in place, it might be hard for the administration to preserve the momentum on uninsured enrollments this year. The picture will be clearer after February 15th, when the second enrollment period ends.

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