It's crunch time to sign up for coverage under President Barack Obama's healthcare law. The website works much better now, but rising premiums and shaken faith among insurers have cast new shadows.
Tuesday is the deadline for millions of uninsured procrastinators to sign up in time for coverage to begin on Jan. 1. As the health insurance expansion enters its third year, their decisions are critical to the marketplace's economic viability. A surge of younger, healthier customers could hold down premiums in a market that's struggling to grow.
"Medical costs of enrollees have been higher than expected, and total enrollment remains low," said Caroline Pearson, a vice president at the consulting firm Avalere Health. "If participation is leveling off, then plans may be stuck with a risk pool that is not particularly balanced."
More than half of the health law's 23 not-for-profit insurance cooperatives have folded, and even some major industry players have recently gone public with doubts.
Still, HHS is trying to put a positive spin on enrollment, reporting Tuesday that HealthCare.gov saw an all-time high of over 185,000 consumers simultaneously shopping last night. The marketplace took nearly a million calls Monday.
“Because of this surge in consumer demand, we'll continue to have some consumers wait a few minutes before logging in,” said HHS spokeswoman Lori Lodes in an e-mail, adding that the average wait time was about two minutes.
Earlier this year, HHS predicted only a small increase in the number of people signing up for insurance through Affordable Care Act exchanges for 2016. The estimate of 10 million enrolled by the end of the third open-enrollment period is less than half of what the Congressional Budget Office had projected would be covered for the year.
There have been other bumps with the health law, says business owner Rayna Collins of Lincoln, Neb., but overall she counts on it. She's surprised, however, that many people she knows have remained uninsured.
"It's heartbreaking to think that they could have affordable insurance," Collins said. "They think it's like going on welfare." One friend believed incorrectly that insurers could still turn down customers with pre-existing health conditions, a practice barred under the law.
Collins, a graphic designer, has had to make adjustments. She switched insurers for 2016 because the company she was with left the market. Her premium will be about the same after subsidies the law provides for private coverage. But her deductible will spike from $500 to $2,600.
"I'm getting less coverage for about the same, and I'm not happy with that," Collins said. "But I don't know what I would do if I weren't getting the government subsidy. I was already being priced out of health insurance before Obamacare." The coverage allows her to get regular preventive care that's important for people like her, in their early 60s.
The Obama administration says it's seeing a vigorous consumer response this sign-up season, with more than 1 million new customers already.
"All the evidence for us is that the marketplace is strong, it's vibrant, and it's growing," said Andy Slavitt, head of the CMS, which runs the government's major insurance programs.
Some important things for consumers thinking about signing up for the first time, as well as for those renewing:
- Deadlines: Tuesday is the deadline to sign up for coverage so it can take effect on the first of the year. It's also the deadline to make any changes to existing coverage so they take effect Jan. 1. Current customers will be automatically renewed Jan. 1 if they make no changes, but they may save money now by shopping for a plan with lower premiums.
The final deadline for new sign-ups and plan switches is Jan. 31. After that, new enrollments and changes are only allowed under special circumstances. People who remain uninsured after Jan. 31 risk fines when they file their 2016 taxes.
- Fines will sting: The fines for people who remain uninsured in 2016 have gone up substantially. A study from the nonpartisan Kaiser Family Foundation estimates that the average tax penalty will rise to $969 per household, or nearly 50%. The fines are one of the law's methods for nudging healthy people to get insured.
Fines of $900 would put a serious dent in most income tax refunds, and it's enough money to pay several months' worth of subsidized premiums. This year uninsured people got a second chance to sign up and avoid penalties if they found out about the fines upon filing their tax returns. There's no such reprieve next year.
- Website working: The HealthCare.gov website, famously balky a couple of years ago, is working well by most accounts. The site has some consumer-friendly enhancements including a cost calculator, a doctor and hospital look-up feature, and a way to see whether your prescription drugs are covered. Consumers are urged to double-check the physician finder results with their plans and doctors.
Drew Altman, president of the Kaiser Foundation, says the health law's insurance markets appear to be making progress. But they're not there yet.
"It's going to take more people enrolled to be fully successful," Altman said.