HHS is predicting about 9% more people will sign up for coverage on the Affordable Care Act exchanges during the next open-enrollment period, but the estimate is still below the most recent projections from the Congressional Budget Office.
The final open-enrollment period for the Barack Obama administration begins Nov. 1. That is just one week before voters head to the polls to elect the next president. The candidates have presented starkly different plans for the future of healthcare, with Democratic nominee Hillary Clinton saying she would build upon and strengthen the ACA and Republican nominee Donald Trump vowing to repeal it.
Despite the ACA helping achieve a record low rate of uninsured, the ACA exchanges have hit a few roadblocks . Three major insurers have drastically scaled back their participation, leaving four states with only one insurer offering exchange plans in their market. People whose insurer will no longer offer coverage will be matched up with another carrier's plan. It's up to the consumer whether or not to accept the match or keep shopping.
States have also been warning that premiums are likely to increase dramatically.
HHS has said the rate increases are the natural result of insurers adjusting to the market as they gather more consumer data. A report from the agency states that most people who receive premium subsidies will be able to find a plan costing $75 a month or less.
An estimate from HHS' Office of the Assistant Secretary for Planning and Evaluation projects that 13.8 million people will have selected a plan by the end of open enrollment for 2017. This would be an increase of 1.1 million people, or 9%, from 2016. The estimate for monthly active, or effectuated, enrollment is 11.4 million people over the course of 2017.
That number remains below the most recent enrollment estimates from the CBO, published in March. It predicted 15 million people enrolled in the marketplace during 2017. An issue brief from the Office of the Assistant Secretary for Planning and Evaluation suggests the discrepancy is the result of fewer people than expected switching from employer-based plans.
HHS Secretary Sylvia Mathews Burwell said in a statement that the administration has struggled to build the exchange market despite partisan attempts to bring down the ACA.
“We've put our ideas on the table to build on the historic progress achieved under the ACA and continue to improve America's healthcare system,” she said. “We need partners. And we are hopeful that soon, we'll see bipartisan collaboration in Congress and the States that will help us make improvements to the law.”
Experts say the federal government could revise tax and other policies to encourage people in employer health plans to shift to the exchange market.
There's also industry support for allowing insurers to charge older enrollees premiums four or five times higher than those charged to younger members, up from the ACA's current age-band limit of 3-to-1. It's thought that would reduce rates for younger people and persuade more of them to buy insurance—though it also could force older enrollees to drop coverage due to higher prices.
The CMS recently outlined its plans for a more robust outreach campaign this open-enrollment period, aimed in particular at young adults. They include ramping up direct mail and email messages that emphasize ACA deadlines and penalties as well as plan affordability, along with more targeted media platforms.
Consumers also will be reminded that going without health insurance risks a fine from the Internal Revenue Service. The basic penalty is now $695.
