Millions of Americans remain uninsured, yet the Obama administration expects to make virtually no progress this season toward enrolling more of them in Obamacare health plans, according to estimates released Thursday.
Health and Human Services Secretary Sylvia Mathews Burwell is pegging the sign-up goal for the third year of Obamacare enrollment at a modest 10 million people, only slightly higher than the 9.9 million who paid for plans last year and less than a million above last year’s expectations.
That’s also well below the most recent projection by the Congressional Budget Office, which estimated that in 2016, 20 million Americans would have coverage through private plans sold in the insurance marketplaces set up under the Affordable Care Act.
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“I’m going to write a blog post and the title will be ‘Has the Obama administration given up on Obamacare?'” said Bob Laszewski, a consultant at Health Policy and Strategy Associates.
“In 2013, had I said to the world that Obamacare is only going to enroll half of the estimated people, what do you think Obama would have said?” he added.
The administration did give a partial explanation for the reduced enrollment expectations, noting that when CBO constructed its estimates, it mistakenly assumed that more employers would strip their workers of health coverage and send them to the marketplaces than actually did.
“Early projections for marketplace sign-ups envisioned a significant migration from employer-sponsored coverage,” Burwell told reporters. “That shift has not occurred.”
“I think it has to do more with the allocation of the uninsured than how many are going remain uninsured,” said Tim Jost, a prominent supporter for the healthcare law and a professor at Washington and Lee University.
Yet even if all of the 6 million people the Congressional Budget Office projected would lose employer-sponsored coverage remained in their plans instead of going to the exchanges, the 10 million target would still fall short of the agency’s enrollment estimates.
And that development has opponents of the healthcare law blasting the administration for overstating how attractive its benefits would be to low-income Americans who are eligible for subsidies to make the plans more affordable.
While officials have acknowledged that convincing the remaining uninsured to sign up will be a challenge, they also have hailed the law for spurring the biggest reduction in the uninsured rate in decades.
“It is clear the exchanges are not as popular as supporters hoped,” said Michael Cannon, director of health policy studies for the Cato Institute.
Last year, HHS projected 9.1 million Americans would enroll, a figure also below CBO projections. Both Cannon and Yuval Levin, editor of National Affairs, said the agency may again be “lowballing” the figure to look more successful once the signup period has concluded.
“I think this is in part HHS’s usual low-balling to achieve ‘surprisingly high’ headlines when a slightly higher number comes out after the 2016 enrollment period, and in part of course a recognition that the exchange system is failing to attract consumers, because it doesn’t allow insurers to offer attractive and economically sensible products,” Levin said.
Enrollment in the Obamacare plans started on Nov. 1 and lasts through the end of January. While millions of Americans have gotten insurance both through the marketplaces and through the healthcare law’s Medicaid expansion, about 32 million still lack coverage.
Of the people who initially enrolled in coverage last year, a significant portion never paid their first month’s premium or later dropped out of their plans because they stopped paying. The administration expects a similar outcome this year, estimating that while 11 to 14.1 million people will choose plans, just 10 million will actually complete the process and have paid all their monthly premiums by the end of 2016.
Burwell called the 10 million target a “strong and realistic goal.”
“I have the responsibility to manage this program on a day-to-day basis, and I don’t have the luxury of a range,” she said. “I believe in clear metrics and goals, so like last year, I have picked a point that we will manage for.”
Burwell has emphasized that reaching the remaining uninsured will be difficult, since they’re holdouts who never signed up during the first two enrollment seasons. Some just haven’t heard they’re eligible for subsidies, others find the plans too expensive regardless of financial assistance and others would rather pay the penalty for remaining uninsured.
Chris Jennings, a healthcare adviser to the Obama administration while the law was being implemented, explained the lower enrollment projections by pointing to fewer employers dropping workers from plans. He emphasized that regardless of how quickly Americans are signing up for coverage, the uninsured rate is lower than it’s ever been.
But he also suggested that maybe the subsidies should be increased to motivate more people to sign up.
“This is not to say that keeping and adding more numbers to the ranks of the insured isn’t a challenge. It is and will be,” Jennings said. “This is why the financial incentives and other provisions of the law are so important. If anything, over time, they may need to be enhanced.”
