4 ways ACA exchange enrollment has fallen short

Capitol Building on Capitol Hill

Though the Affordable Care Act has made significant strides in reducing the number of uninsured Americans, the sustainability of the exchanges is threatened by the fact that enrollment has not lived up to expectations, according to a new report.

The report, from the Council for Affordable Health Coverage (CAHC) with assistance from Avalere, points out that the Obama administration expects only 10 million exchange enrollees by the end of 2016--well short of the Congressional Budget Office's initial projection of 21 million, which it has since revised.

In addition, exchange enrollment at the end of the year is typically about 20 percent lower than at the close of the annual open enrollment period--an attrition rate that the report says threatens market stability.

Here are four other ways exchange enrollment has fallen short:

  • While women comprise only 45 percent of the potential exchange population, 54 percent of 2016 enrollees are female, suggesting many potential male enrollees are not signing up for coverage.
  • Only 15 percent of exchange enrollees are Hispanic, though Hispanics could potentially make up 23 percent of the exchange population.
  • Less than 40 percent of enrollees are younger than 35, though 50 percent of the potential exchange population is in this age bracket, reflecting a missed opportunity to enroll young, healthy consumers.
  • Only 2 percent of the potential exchange population who are not eligible for subsidies have enrolled in exchange coverage as of 2016.

 "I think the takeaway from these numbers is the ACA isn't living up to expectations and its potential," CAHC President Joel White said on a conference call with reporters Tuesday.

The solution, White's organization says in the report--as it has previously--is to implement "next generation exchanges" powered by innovations in the private sector. CAHC envisions a model that would include, among other factors, private shopping websites that would compete directly with public sites, and a more "modern" eligibility process that would make subsidies portable.

Though the election year and often-intractable political divisions in Congress make passing such a proposal challenging, White said on the call that he remains optimistic. CAHC hopes to get a bill introduced this year in preparation for a new administration in 2017.

"We're thinking it's now time for a course correction," he said, adding that Congress has actually seemed to be "surprisingly willing" to take up ACA changes in recent years.

To learn more:
- here's the report (.pdf)