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.
The real test is whether people’s health improves or not. Having “insurance” is no good if people are unable to use it due to narrow networks, procedures/medications “not covered”, inability to pay increasing premiums and co-pays, etc. There is a lot of cheerleading going on but it is way too early to determine the success of this very complicated program. So far it hasn’t done much to bring down the actual costs of healthcare, which is the real problem facing the health care system.
asksurfer —
All medically necessary procedures and meds are covered, and in June, Kaiser’s poll showed that people who have insurance that complies with
Obamacare’s rules are especially happy with their choice of providers.
Clearly, you’ve been absorbing the misinformation that Fox, Forbes and others are circulating.
I have an Exchange policy with a closed network of providers–and everyone I now see is in that network. Every hospital I might want to visit is in that
network. The hospitals and providers who are not included are those that overcharge and, at the same time, get poor marks for quality of care.
(Overcharging and poor quality often go hand in hand.)
As for cost–I just received a letter saying that in 2015, my premiums will go down by 10%. And my policy has no deductible and very low co-pays.
My situation is far from unique. In virtually every state one or more insurers are cutting premiums for 2015. Competition is increasing as more
insurers participate in Obamacare.
Finally, nationwide, the growth in total spending on healthcare has slowed significantly, and this includes spending on Medicare.
Hospitals, in particular, are making a greater effort to avoid preventable errors and to become more efficient. They know that under Obamacare
we will be pay for quality (better outcomes at a lower price) not quantity (feee-for-service–the more you do to a patient, the more you are paid.)
The Accountable Care Organizations are already up and running.
I do think complaints some necessary procedures might not be covered should be taken seriously. Insurers are still able to make independent decisions on what to cover, and still find ways to deny care.
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.
Gladly paid, rather than participating in farce.
Ben—
Everyone has a right to making their own decision.
But I do hope you understand that if you don’t have insurance, you are not going to receive care unless you
can pay for it out of pocket. IF you arrive at a hospital’s ER, the hospital is required only to “stabilize” you–which is defined as patching you up so that
you can “walk out the door.” But no surgery, no chemo if you have cancer, et.
Great stuff, Maggie. Refreshing to find a Progressive Blogger who sort of burrows into things, and is able to take the perspective of the consuming public, and see, as if from the inside-out, what is trying to emerge. Would love you to look at my blog on The Budget Game Has Changed (URL above). Have been studying all this for 6 years, and think we are at a key point of transformation. Send me a note at my email above, or on Twitter @jstuart902.
Jim–
Thanks very much. I did look at your blog (jimstuartnewblog.blogspot.com) and would urge others to look at “The Budget Game has changed.”
Yes, spending on Medicare has slowed significantly, largely because hospitals are making a concerted effort to become more efficient. They know that
in the very near future they will be paid more if they produce better outcomes at a lower price. And they will be penalized if that don’t rein in preventable
errors. Some doctors also are becoming more cost-conscious; rather than simply ordering a battery of tests, they’re asking questions, listening to the patient, and then ordering
the test or tests that seem appropriate. In the future, doctors who create medical homes will be rewarded if they manage to keep chronically ill patients out of the
hospital. Finally, some patients are becoming more aware of the dangers of over treatment.
This is also happening in the private market, but it’s harder to draw clear evidence from the private market because there is so much “noise”–
clouding the picture. But the Health Affairs article which claims that spending is slowing only in depressed economies is simplistic.
As I’ve always said, reform will be a process, not an event. But over time I’m convinced that health care spending will level off. Ideally
health care spending, as a percentage of GDP, will stabilize about where it was in 2006–or earlier. (Of course, that assumes we see some
GDP growth).
> 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 27.
What? Dependents lose coverage on their 26th birthday, not the 27th.
Zarla–
Thanks much. That was a typo, and I’m fixing it now
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Maggie:
I’ve been looking for new posts from you. I hope you’re doing OK. I have a specific question and I thought you would be the best person to answer this due to your extensive knowledge of the ACA. Now that the exchanges have been around for more than a year, would you say that more Americans (overall, not just those in the non-group market) are able to keep their doctors than before, or fewer? What will be the case going forward?
My main buff about this is that it’s tied directly to your taxes and that there are no natural alternatives for people who don’t believe in the sick doctor system that the United States seems to embrace so well. I choose to eat right and live well. Those are qualities that don’t seem to be addressed in this “get sick and stay sick” society.
Lisa–
Actually Obamcaare is all about encouraging people to stay well. This is why preventive care is free.
IN addition, however well you eat and live, you will, one day, die. You could be killed in an accident, but more likely, you will become
very sick. AT that point, you will need healthcare. (Unless you want to die in great pain.)
However well you eat and live, you are vulnerable to diseases that you cannot control by “living right”: examples–many kinds of cancer as well as Alzheimer’s, MS., etc.
This is why everyone needs to sign up for healthcare–or pay a penalty. (The penalties will help cover the cost of their care when they
do get sick. Chances are, as you grow older, you will be very sick more than once. Healthcare may save your life 2 or 3 times, before your final illness.
Finally, if you make it into your 70’s, chances are very high that you will be diagnosed with Alzheimer’s (For female baby-boomers in their
70s, we are told the odds are 1 in 3.)
At that point you will need much healthcare–probably for 6 or 7 years (that’s how long many Alzheimer’s patients live.)
This is why you, like everyone else, needs universal healthcare–