(Story updated at 1:10 p.m. ET.)
Roughly 17.6 million Americans have received some type of health coverage since the Affordable Care Act was passed five years ago, HHS Secretary Sylvia Mathews Burwell said Tuesday. That's a 1.2 million bump from a previous estimate released in March.
HHS also estimates, however, that about 1 million fewer people will have active insurance through an exchange than the number who had selected and paid for a plan as of March 31. Burwell said the figure is projected to be 9.1 million by Dec. 31, down from 10.2 million earlier this year.
The figure is still in line with HHS stated goals for the number of people it expected to be paying for coverage by the end of the year. The agency has yet to release a goal for 2016.
Officials offered little explanation about the drop in exchange enrollment other than to note some were expected to get employer-sponsored plans as the economy continues to improve.
The increase in the number of people with insurance is primarily the result the ACA's health insurance exchanges and expansion of Medicaid to people who earn up to 138% of the federal poverty level, according to a report from HHS' Office of the Assistant Secretary for Planning and Evaluation (PDF).
About 15.3 million adults gained health coverage through those two provisions or through their employers. Another 2.3 million young adults age 19-25 were able to stay on their parents' health plans until they turned 26 thanks to a provision in the ACA.
The uninsured rate fell most precipitously among African-Americans and Latinos. The uninsured rate declined 11.5 percentage points for Latinos and 10.3 percentage points for African-Americans. The uninsured rate dropped 6 percentage points for whites.
“When we look at the evidence, the Affordable Care Act is delivering on access, affordability and quality,” Burwell said Tuesday during a speech at Howard University's Hospital.
About 10.5 million uninsured Americans are eligible for marketplace coverage in the upcoming open enrollment. Almost half are between age 18 and 34, and one-third are people of color (19% Hispanic, 14% African-American and 2% Asian American).
“Our research tells us that they will be harder to reach,” Burwell said. “We've found that costs are still a big concern—about half of the people who are uninsured have less than $100 in savings.”
Affordability could pose a significant barrier in getting the remaining eligible signed up, according to Cynthia Cox, associate director of health reform and private insurance at the Kaiser Family Foundation.
Even with the subsidies, the premiums may still be too much for some to handle, Cox said.
Paul Keckley, managing director of the Navigant research center, noted that figures coming from several states indicate many payers intend to raise premiums, mostly in response to high drug prices.
HHS will focus much of its resources on outreach in Dallas, Houston, northern New Jersey, Chicago and Miami, which are home to the highest numbers of uninsured who are eligible for exchange plans.
Experts say the regional approach makes sense. “The large proportions of young adults and people of color who are uninsured but qualify for Marketplace plans point to the need for more targeted outreach,” said January Angeles, senior policy analyst at the Center on Budget and Policy Priorities.
With limited funds, HHS will solicit help from grassroots allies, relying on figures like radio DJs and church leaders to spread the word.
The administration also plans to highlight that most marketplace recipients were able to get coverage for less than $100 a month after subsidies—and that people who fail to get coverage face a tax penalty. The penalty next year will be $395 per uninsured person or 3% of household income.
The third open enrollment poses significant challenges. The people most enthusiastic about obtaining coverage, such as people whose preexisting conditions made insurance prohibitively expensive, have already done so, according to Ron Pollack, executive director of the consumer group Families USA.
However, Pollack noted, sharing the stories people who already signed up could in fact be HHS' most powerful argument in persuading the remaining uninsured of the value of getting covered.