Last fall's botched launch of HealthCare.gov was a political disaster for Democrats that may have contributed to last week's big Republican election gains. Now, open enrollment faces its second test starting Nov. 15, and federal and state officials along with healthcare stakeholders are working hard to ensure the process goes more smoothly this time.
If sign-up procedures and the volume of enrollments are seen as a success, it could greatly help the Patient Protection and Affordable Care Act survive the coming onslaught from the Republican-controlled Congress in 2015. And it would bolster Democrats politically heading into the 2016 elections.
But if the next open enrollment is deemed less than successful, it could spell big problems for the law and for Obama's party, particularly if there are serious website failures. “I don't think there's going to be much forgiveness if they blow that one again,” said Eric Zimmerman, a health law partner with McDermott Will & Emery.
Despite last fall's problems, exchange sign-ups exceeded expectations as 7.3 million enrolled in individual-market plans. Insurers have shown confidence that the new markets are viable and increased their exchange participation for the second open enrollment.
The Congressional Budget Office has projected that enrollment in private plans through the exchanges will reach 13 million in 2015. But many experts say that remaining uninsured Americans will be harder to reach because most people who were highly motivated to obtain coverage have already signed up. Further complicating matters, the three-month enrollment window for 2015 is only half as long as the first sign-up period. If enrollment falls short of the CBO's estimate, Republican critics likely will use that as ammunition for scrapping the law or significantly scaling it back.
Joel Ario, former director of HHS' Office of Health Insurance Exchanges, said the open enrollment is an opportunity to marginalize Obamacare opponents calling for repeal.
“The narrative of growth becomes important to make those voices less and less credible,” Ario said.
Zimmerman agreed that enrollment growth will help “ingrain the program in the psyche of the American public. That's the only thing that's really going to transform it as a campaign issue in 2016.”