Obama admin projects 9 percent uptick in ACA enrollment


The Obama administration remains optimistic about enrollment growth on the Affordable Care Act marketplaces in the upcoming open enrollment period despite rising premiums and downsized competition on the exchanges.

Exchange plan enrollment is expected to reach 13.8 million by the close of open enrollment, a 9 percent increase from 12.7 million at the end of the last sign-up period, according to a new analysis from the Department of Health and Human Services Office of Assistant Secretary for Planning and Evaluation (ASPE).  

The administration is banking on new signups from its outreach efforts to the 10.7 million uninsured individuals, approximately 85 percent of whom are eligible for financial assistance, according to HHS.

Even though she is optimistic about the future of the ACA marketplaces, Department of Health and Human Services Secretary Sylvia M. Burwell says that placing party interest above national interest has stalled progress on improving the exchanges. "We put our ideas on the table. We want to work together. We need a partner," Burwell said Wednesday.  

Still, as the uninsured population shrinks, it's also the case that potential enrollees become harder and harder to reach, Deep Banerjee, director and sector lead at S&P Global Ratings, told FierceHealthPayer via phone Thursday. It’s a matter of diminishing marginal returns to the cost of outreach efforts, Banerjee says.

Ostensibly, the results of HHS’ model contrast to S&P’s recent prediction of "moderate to negative" enrollment growth for the exchanges in 2017, but the key measure to note, says Banerjee, is what the average annual enrollment will be after accounting for enrollee drop-outs.

On this front, Banerjee’s team forecast an effectuated enrollment to range between 10.2 million and 11.6 million, FierceHealthPayer reported last week. HHS indicates that effectuated enrollment will hover around 11.4 million, indicating that the reports are not in fundamental discord, Banerjee continued.

The 11.4 million figure does not account for sign-ups through New York and Minnesota’s Basic Health Plans that enroll 650,000 individuals, HHS notes.

The “key difference” between S&P's prediction and the Obama administration’s prediction is the addressable market, says Banerjee. HHS estimates new plan selections to fall between 4.3 to 5 million, whereas Banerjee and his team estimate new plan selection to range between 1.9 and 2.4 million.

There are at least two reasons HHS’ forecast numbers could be inflated, writes Tim Jost, emeritus professor at the Washington and Lee University School of Law, in a Health Affairs Blog post.

  • First, 4.5 million of the 27 million uninsured population qualify for employer-sponsored insurance coverage yet choose to forgo this option, according to a Kaiser Family Foundation analysis released earlier this week.  If these employer-sponsored plans are affordable and meet minimum coverage requirements, such individuals would become ineligible for financial assistance. ASPE’s analysis does not factor this point into its models, Jost argues.
  • Secondly, Jost says the number of uninsured individuals HHS estimates will actually enroll on the health insurance exchanges may be higher than what will play out. Some of these individuals find employer sponsored-insurance unaffordable and are also ineligible for financial assistance on the marketplace, he says.