Thanks to the Affordable Care Act, some 10 million previously uninsured adults gained coverage during the open enrollment period that began on October 1, 2013. Last month, the New England Journal of Medicine reported that the share of Americans who are “going naked” has plummeted from 21 percent in September of 2013 to 16.3 percent in April of this year.
Even though open enrollment officially ended on March 31, 2014, people are continuing to sign up. Anyone who experiences a major life change (getting divorced, losing a job, having a baby) can still purchase insurance on the Exchanges this summer. Others are dropping out because they landed a job, married someone with insurance, or turned 65.
Earlier this month, Aetna told Investor’s Business Daily that the degree of attrition was “scary” and “unexpected,” and as a result, enrollment is “shrinking.” But enrollment expert Charles Gaba soon put that rumor to rest. Perhaps Aetna is losing customers, but overall, enrollment is holding up. Indeed, ultimately, the Congressional Budget Office (CBO) projects that by the end of 2014, 12 million formerly uninsured Americans will be covered either by the Obamacare insurance they purchased on the Exchanges or by newly expanded Medicaid programs.
On November 15, a new open enrollment period begins. Now the big question is this:
Will the ACA Be As Popular In 2015 As It Was In 2014?
Over at the Huffington Post, Jeffrey Young is pessimistic. In a post headlined “Why Obamacare May Have Trouble Signing Up As Many Uninsured Next Year,” he quotes Richard Onizuka, the CEO of the Washington Health Benefit Exchange saying “we got the low-hanging fruit” last year. The people who most needed healthcare signed up right away. These include folks with pre-existing conditions, who had been shut out of the market under pre-Obamacare rules.
By contrast, in this second round of enrollment, Young points out that reformers will be trying to sign up people who are not desperate for insurance, and who may be harder to reach, including: “Hispanics . . . people who have less education, live in remote rural areas . . . don’t have Internet access or don’t consume news.”
Moreover, Young notes: “public opinion about the law itself is negative.” Indeed, nationwide polls show that approval ratings for Obamcare have been sinking in recent months. Reform appears less popular than it was when enrollment began in October of 2013. As a result, Young believes that enrollments will tumble: The CBO now predicts that just 7 million Americans will gain insurance in 2015.
But as I will point out in my next post, there are indications that in states where Obamacare enrollments have been most successful–including Red states– the Affordable Care Act (ACA) may be about to turn a corner, even among Republicans.
This explains why Republican Party leaders who decide how to spend campaign dollars have begun backing away from ads attacking Obamacare. The GOP senses that, going forward, bashing Obamacare will no longer be the best way to bash Obama. Too many people are finding out what a good deal reform is.
Ten Reasons Why Obamacare Will Cover Another 10 Million in 2015
Usually, I agree with Young—his analysis of health care reform is both fact-based and shrewd. But in this case, I’m not persuaded. I can think of at least ten good reasons to expect that another 10 million will either purchase Exchange insurance or join Medicaid’s rolls next year.
- The millions who have already signed up are now telling friends and neighbors about the benefits of Obamacare—including the fact that 87% of them received government subsidies that helped cover premiums. Polls show that while many Americans don’t trust the media’s conflicting reports about Obamacare, they do believe the information they receive from friends and relatives.
- Word-of-mouth will dispel rumors that continue to confuse potential customers. For example, In July a Kaiser Foundation poll revealed that 37% of those polled thought that under the Affordable Care Act, people had no choice of policies. They believed that anyone who bought coverage in an Exchange was shoved into one government-run plan.
- Amazingly, when Enroll America conducted a survey in April, just after the first enrollment period ended, it discovered that 26% of those who had not signed up still had not heard that the government was offering financial assistance to low-income and middle-income people who bought coverage in the Exchanges. Those who did enroll were twice as likely to know about the subsidies (56% vs. 26%). In the months ahead, millions will learn more about true cost Obamacare as friends talk about what they are paying for their policies.
- Many will find that premiums are lower than they were in 2013, in part because more insurers will be selling policies on the Exchange, increasing competition. I recently received a letter from my insurer telling me that, next year the premium on my zero-deductible Exchange plan will be falling by 10%. As state regulators make final decisions about which increases they will and won’t approve, I will be writing more about how many insurers are dropping rates.
- In 2015, the Refuseniks will have to pay a fine that rises from 1 percent of yearly household income or $95 per person (whichever is greater) to 2 percent of household income or $325 per person. A family of four earning $70,000 would have to fork over $1,400—and receive nothing in return.Or that same family can sign up for a subsidy, pay part of the premium and wind up with comprehensive insurance that includes free preventive care, and caps out-of-pocket costs.
- This fall, it will be far easier to use the online websites than it was in the fall of 2013. By the end of the first enrollment period, most sites were working smoothly (though by then many would-be customers had given up). This year, there should be many fewer glitches because the administration has persuaded Mikey Dickerson, the Google engineer credited with fixing bottlenecks on the Healthcare.gov website last spring, to become the government’s full-time IT czar.
- The “navigators” charged with helping customers find plans that meet their needs, either in person, or on the phone, will be that much more experienced, and many will have received more training. There will also be more bi-lingual navigators available.
- Over the next year, more states will expand Medicaid. Political pressure is mounting: states that refuse to take the federal dollars that Washington is offering are leaving too much money on the table, and voters are hearing about it. In North Carolina, for instance, local newspapers are reporting that, over the next decade the state risks missing $51 billion in federal payments. Hospitals would get $11.3 billion of that amount. At present, North Carolina hospitals are threatening to lay off workers. If North Carolina expands Medicaid, another 400,000 Americans would be insured under the ACA. And that’s just one state.
- As low-income people who have joined Medicaid talk to their neighbors, more will become aware that the rules for eligibility are changing. We’re likely to see a major impact in the Latino community where language barriers have blocked government efforts to spread the word.
- More young adults will find out that they can sign up for a parent’s employer-based insurance and stay on it until they turn 26. A Deloitte survey of young adults reveals that in April, 45% still had not heard about this Obamacare benefit.
- The Kaiser Foundation’s July poll reveals that most people who actually signed up for Obamacare rate their policies as “excellent” or “good.” This, along with what I know about how the ACA is helping millions, is the major reason why I am convinced that as the newly insured share their experience with others, public support for health care reform will climb—especially among those who most need it.
- As I will explain in part 2 of this post, some affluent Americans who don’t need the ACA or its subsidies (because they already are covered by employers) may be inclined to remain nervous about Obamacare. But Americans who are wealthy enough to feel that they and their adult children are economically secure are a shrinking minority. This is the one good thing that can be said about growing economic inequality.