Although healthcare.gov sputtered at launch and was riddled with myriad problems, it ‘s enrollment numbers are climbing. As of February 1, 2014, 3,299,492 individuals have selected a marketplace plan. However, I need to make an important distinction with this enrollment number, this is not the number of people who paid for a plan. We won’t get those numbers for a few more months. While I am not an industry analyst, I know this figure won’t convert at 100 percent but will be less – just how less remains to be seen. While the state-based exchanges have, for the most part, fared better than healthcare.gov – healthcare.gov is now gaining steam. With little over a month left for open enrollments, it is hard to say how many of the 49 million uninsured will sign up. But we know enrollments will continue to increase.
Let’s look a few challenges that still remain:
1) Cancelled policies under Obamacare – Recently, as of 2/7/2014, reports have stated that the Obama administration is considering an extension of the president’s decision to let people keep individual health insurance policies even if those policies are not compliant with the ACA. While a decision on this has not been made, it appears that the administration is considering allowing policyholders to keep coverage for three additional years. At least 4.7 million cancellation notices were sent which created a huge uproar that the administration is still trying to quiet. So it looks like we still have to wait a bit to see exactly how this plays out and if an extension is granted, will it bring any relief to the impacted public.
2) What happens to uninsured – While the numbers are growing, there are 49 million people who do not have insurance. There is little doubt that a number of them will choose not to enroll before March 31, when open enrollment closes. There have been considerable discussions centered on the penalties that one will incur if they choose not to enroll. But not much talk has centered what happens if they do not enroll and need care. If this does happen, it is no longer the case of showing up at the emergency room for urgent care and that simply walking away. Now the uninsured will have to pay the entire cost of their medicare care, without any protection from high medical bills.
3) Get the “young invincibles” on board – One of the main goals of all the marketplaces is to get the young invincibles enrolled. Some states have rolled out significant marketing outreach campaigns specifically targeting this market. Unfortunately, for some, the messages have been controversial but not necessarily effective. Ads featuring “frat boys” doing keg stands (you might want to google the term if not familiar) and call outs for birth control have received flat response. There is still a lot of work to be done and they may have missed the window for this open enrollment. But hopefully by November’s open enrollment, they will have dealt with educating the young market with thoughtful, engaging but non-offensive messaging that imparts the seriousness of the issue.
4) Fix the backend – Core to the success of heathcare.gov is fixing all of the ongoing issues. Carriers are still receiving enrollment files that have missing and/or inaccurate information. The system still appears to have bugs or coding errors that have yet to be repaired. Plus CMS is still building the payment and reconciliation part of the system. This is a huge piece of the marketplace that was placed on hold to deal with the more visible front-end issues.
Collectively addressing the above issues will put the health insurance exchanges in a much better place for the November enrollment period. Regardless how this turns out in the end, it will be an interesting year.