The Obama administration has set a more ambitious Obamacare enrollment goal than last year, but it may not dent the country’s still-sizable uninsured rate.
Officials announced Wednesday that they expect 3.5 million uninsured people to select a marketplace plan in the upcoming signup season, a small fraction of about 19 million people who still lack coverage and could feasibly buy it.
If all those 3.5 million people paid for their plans and maintained coverage throughout the year, it would reduce the ranks of the marketplace-eligible uninsured by 18 percent. But the reduction in the uninsured will be smaller than that, as some people who initially select a plan won’t follow through and complete their enrollment. And as uninsured people enter the marketplaces, others will drop out.
The administration expects a net increase of 1.1 million more Americans with marketplace plans at the end of this enrollment season than last year. And given that 1.1 million of the enrollees are projected to be entering the marketplaces from off-marketplace plans, there may be no improvement at all in the uninsured rate when sign-ups end Jan. 31.
“There is sort of no net increase in people with individual insurance, so even though they’re anticipating enrolling 3.5 million currently uninsured, that doesn’t mean there will be a net drop of uninsured people,” said Kaiser Family Foundation Vice President Larry Levitt.
Even with the major provisions of the Affordable Care Act in place, about 27 million remain without coverage, according to a recent Kaiser survey. About 5.4 million are illegal immigrants who aren’t eligible to buy on the marketplaces and another 2.6 million live in states that would be eligible for Medicaid but live in states that haven’t expanded it.
That leaves about 19 million people who could buy insurance or enroll in Medicaid but are choosing not to because they can’t afford it, think they can’t afford it, don’t know about it or have made a decision they would rather pay the federal penalty for failing to buy coverage.
The large swath of remaining uninsured is a troubling prospect for advocates for the law, who had hoped to dramatically reduce the uninsured rate and attract a large share of young, healthy adults to the marketplaces.
Department of Health and Human Services Secretary Sylvia Burwell spoke optimistically about outreach for the marketplaces in the upcoming enrollment season starting Nov. 1. But despite more targeted marketing strategies, the agency expects just 1 million more people to select plans at the end of this signup season than last year.
As other administration officials have done, Burwell pointed to the availability of insurance subsidies as a way to convince people to buy coverage. As for those who earn too much to get subsidies, she stressed that the marketplaces make it easier for customers to shop around and compare plans.
“We know we now have a marketplace where you’re giving people tools to shop,” Burwell said in a speech Wednesday.
Some leading Republicans criticized the administration’s assurances that this enrollment season will go better than before. Rep. Kevin Brady, chairman of the House Ways and Means Committee, pointed to enrollees who have seen their premiums rise or had to choose different plans as their current insurers exited the marketplaces.
“The administration’s glowing predictions pale in comparison to the millions of Americans who have been kicked off of their healthcare plan, cannot afford their monthly premiums, and cannot visit the doctor they’ve seen for years,” Brady said.
