Along with releasing end-of-the-year 2015 enrollment data for the Affordable Care Act exchanges last Friday afternoon, the Department of Health and Human Services also released data for the 2016 open enrollment period. Just like the end-of-the year 2015 enrollment data, which I discussed on Monday, a close look at the 2016 open enrollment data reveals that the ACA is significantly underperforming initial expectations.
The big story is how little has changed from 2015 to 2016. The number of 2016 exchange enrollees is up only slightly from last year, and the make-up of the risk pool—as proxied by income and age of enrollees—is virtually identical.
The co-ops represent a modest component of the sweeping 2010 health law that put new coverage requirements on insurers and required most Americans to have health insurance or pay a penalty. The co-ops were included to foster nonprofit health insurance providers to compete in the individual and small group markets.
The report will be released in advance of a Senate Finance Committee hearing on Thursday. It is likely to spur more questions about prospects of the Obama administration’s $2.4 billion co-op program.
Thousands of doctors, hospitals and providers in some states still haven’t been paid for health services given to members insured by the co-ops. More than half a million people signed up for health insurance under the ACA lost coverage or had to get new insurance because their co–op had folded.
Last year’s final enrollment numbers under President Barack Obama’s health care law fell just short of a target the administration had set, the government reported Friday.
The numbers are important because the insurance markets created by the president’s 2010 health care law face challenges building and maintaining enrollment. The marketplaces offer subsidized private insurance to people who don’t have access to job-based coverage.
The report from the Health and Human Services Department said about 8.8 million consumers were still signed up and paying premiums at the end of last year.
HHS Secretary Sylvia M. Burwell had set a goal of having 9.1 million customers by then.
Ask the price of anything and the answer is always the same: What insurance do you have? Patients are blocked from shopping for fair value. The part of the Affordable Care Act which was supposed to control insurance costs, perversely, incentivizes insurers to pay higher, not lower costs. Under the Affordable Care Act, premiums and profits are legally permitted to rise only as health costs rise. In short, when it comes to pricing, nobody is watching the store and citizens cannot shop to protect themselves from medical price gouging.
This former hospital president says that because billing rates are not set, the health industry is able to prey on patients at their most vulnerable. And if you are out of network or uninsured, you pay the highest rates.
When agencies release information on a Friday afternoon, it is generally because of unfavorable news they hope will lose potency over the weekend. On Friday, the Department of Health and Human Services (HHS) released 2015 end-of-the-year exchange enrollment data. After reviewing the numbers, it is understandable why HHS would want this release to attract as little attention as possible.
Most news stories reporting the numbers have focused on the large overall decline in exchange enrollment throughout 2015—down 25% from the number of people who selected a plan at the end of open enrollment—or how the end-of-the-year number failed to meet even HHS’ downgraded target. The most striking number from the data, however, is the large drop in exchange enrollment—equal to about 1.13 million people—during the last six months of the year. As I explain below, this large net decline is problematic for the future of the Affordable Care Act (ACA) as it likely exacerbates other adverse selection problems induced by the law.
Funding a problem doesn’t solve a problem. There are ways to make health care more affordable and accessible with less government dependence. For starters, Congress should seriously reconsider the way the program is financially structured so states can be granted more flexibility to devise ways that can improve the value Medicaid brings to its beneficiaries.
The other component involves reducing regulation to make medical care more affordable, like repealing Certificate of Need, permitting mid-level providers to practice within their full scope of authority, exercising right-to-try laws, reducing the number of health insurance benefit mandates, or changing the federal tax code to allow the direct primary care market to expand.
Earlier this year a report from the University of Pennsylvania found all but the most heavily subsidized ObamaCare enrollees would generally be better off financially if they forgo coverage and pay for their own medical care out of pocket. The group whose incomes fall between 1.38 and 1.75 times the poverty level will spend about three times the amount on premiums for a Silver plan as their out of pocket health care spending had they remained uninsured. For those earning more than 250 percent of poverty, most will be worse off financially compared to having remained uninsured. By design Obamacare is a bad deal for most people! Basically, except for the unlucky few who experience catastrophic health complaints, the vast majority of ObamaCare enrollees would be better off uninsured.
The number of people who signed up for health insurance for 2016 on the state and federal exchanges was up to 40% lower than earlier government and private estimates, which some say is evidence that the plans are too expensive and that people would rather pay a penalty than buy them.
In 2010, the non-partisan Rand Corporation estimated 27 million people would have exchange policies this year and the Congressional Budget Office at that time was estimating 21 million for 2016. CBO even said last June that 20 million people would have plans purchased on the exchanges this year. Just 12.7 million signed up for plans, however, by the end of open enrollment Jan. 31 and about 1 million people are expected to drop their plans—or be dropped when they don’t pay their premiums.
Many contractors who provide farm labor and must now offer workers health insurance are complaining loudly about the cost in their already low-margin business.
Some are also concerned that the forms they must file with the federal government under the Affordable Care Act will bring immigration problems to the fore. About half of the farm labor workforce in the U.S. is undocumented.
“There’s definitely going to be some repercussions to it,” said Jesse Sandoval, a farm labor contractor based in Stockton, California. “I think there’s going to be some things that cannot be ignored.”
With the results now in from the Affordable Care Act’s third open enrollment period, it’s getting increasingly difficult to sugarcoat the extremely low numbers of enrollees relative to original projections. The 12.7 million people who signed up for an exchange plan amounts to just half as many enrollees as was projected by government and private sector research organizations when the ACA passed.
The Rand Corporation predicted 27 million, the Centers for Medicare and Medicaid Servicespredicted 24.8 million, the Urban Institute predicted 23.1 million, and the Congressional Budget Office predicted 21 million.