HHS estimates 10M exchange enrollees for open enrollment 3.0—way short of CBO's projection

Administration says more have enrolled in employer-sponsored plans than expected

The Obama administration on Thursday said it estimates that about 10 million U.S. residents will be enrolled in health coverage purchased through the Affordable Care Act's (ACA) insurance exchanges by the end of 2016.

About 9.9 million U.S. residents are currently enrolled in exchange plans, but administration officials expect enrollment to drop to about 9.1 million by the end of 2015.

HHS estimates

HHS Secretary Sylvia Mathews Burwell said that she expects between 11 million and 14.1 million U.S. residents to enroll in exchange plans during the upcoming open enrollment period, but that some of those individuals will gain coverage elsewhere or fail to pay their premiums.

HHS estimates that those who enroll in exchange plans during the upcoming enrollment period will include:

  • 7.3 million to 8.8 million individuals who will likely re-enroll in exchange coverage;
  • 2.8 million to 3.9 million uninsured individuals who are expected to enroll in exchange coverage; and
  • 900,000 to 1.5 million who will switch to exchange coverage from other health plans.

HHS's goal is to have more than 25% of the 10.5 million uninsured U.S. residents enroll in exchange coverage during the ACA's upcoming open enrollment period, which will begin on Nov. 1.

HHS prediction lower than CBO estimate

The Congressional Budget Office (CBO) earlier this year predicted that more than 20 million U.S. residents will be enrolled in exchange coverage in 2016.

According to the administration, CBO's prediction was based on an assumption that more U.S. residents would switch to exchange coverage from employer-sponsored plans. However, such a shift has not occurred.

Reaching remaining uninsured could be difficult

Meanwhile, the administration has noted it could be difficult to reach those who remain uninsured, as those who were already inclined to enroll in exchange coverage or were easiest to reach have already signed up for exchange plans. HHS Assistant Secretary of Planning and Evaluation Richard Frank said, "[W]e are seeing a much longer path" to enroll those who remain uninsured.

CEO: What hospitals don't understand about the patients of the future

Further, Burwell noted that "the remaining uninsured have a lot of concerns about whether they can afford coverage," even when accounting for the ACA's subsidies.

Still, Burwell said, "While our audiences may be harder to reach, we're working smarter to reach them." 

For example, HHS says it is:

  • Advertising about in-person enrollment assistance;
  • Launching more localized campaigns; and
  • Sending enrollment reminders at effective times.

Administration officials also said HHS plans to make several improvements to HealthCare.gov, such as adding an "Under 30" tab that will provide additional coverage information to individuals ages 30 and younger. According to officials, about half of the remaining uninsured U.S. residents who are eligible to enroll in exchange coverage are between ages 18 and 34.

In addition, officials say the ACA's individual mandate penalties could play a larger role during the upcoming open enrollment period. The penalty this year will increase from $325 or 2% of an individual's income to $695 or 2.5% of income (Sullivan, The Hill, 10/15; Pear, New York Times, 10/15; Carey, Kaiser Health News, 10/15;  Pradhan, Politico, 10/15; Muchmore, Modern Healthcare, 10/15).

Insurance exchanges: The patient access challenge

For hospitals to take advantage of new exchange patients, they'll need to streamline their patient access processes to handle the increased complexities of insurance verification and eligibility, point-of-service collections, and coverage enrollment.


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