HHS is expecting only a small bump in enrollment next year for insurance through the Affordable Care Act exchanges as employers resist dropping coverage and the remaining uninsured are difficult to find and persuade to sign up.
The estimate of 10 million lives covered by the end of 2016 is less than half of what the Congressional Budget Office had projected and the same as those currently covered through the online markets.
HHS Secretary Sylvia Mathews Burwell called the department's estimate a “strong and realistic goal” for the enrollment period that runs from Nov. 1 through Jan. 31.
The CBO expects employers will drop plans for their workers and people with private coverage will switch to HealthCare.gov.
Critics of the ACA say the lowered projections raise questions about whether President Barack Obama's healthcare overhaul will stabilize, especially in light of increased premiums and problems with affordability.
Chris Sloan, manager at the consulting firm Avalere Health, said the projection does seem realistic but is lower than many expected.
Although the projection indicates little growth, the enrollment of 10 million people would still be a critical mass and insurance carriers are committed to the exchanges for now. So even a low estimate is not likely to have much of an immediate political impact, he said.
There were signs that the enrollment number would be a far cry from what the CBO projected, including a report showing an unexpectedly high number of people exempt from the individual mandate. Also, the people who still do not have insurance are more likely to be low income and thus receive an annual tax rebate. In that case, their penalty would come out of the rebate and not be as obvious, he said.
“It's not like you are pulling out your checkbook and writing a check for X amount of dollars,” he said.
The CBO had a tough task predicting economic trends and employer behavior several years out. Companies appear to be bucking expectation and are continuing to offer coverage as a way of attracting workers in an improving job market, he said.
“At some level offering health insurance is a way to attract people to your firm,” he said.
The total number of eligible uninsured is about 10.5 million. The goal this year calls for signing up about a quarter of them. Burwell said that nearly all of that 10.5 million would be eligible for financial assistance, but most don't know that or misunderstand how that works.
CMS spokeswoman Lori Lodes said the department understands that the remaining uninsured will be more difficult to reach and is developing directed advertising and education to try to get them signed up.
The penalty for not having insurance next year jumps to $695 per person or 2.5% of household income, whichever is higher. Last year, the penalty was $325 or 2% of income.
