— Kathleen Sebelius (@Sebelius) March 27, 2014
“As this historic open enrollment period enters its final days, more than 6 million Americans have signed up for coverage through the Health Insurance Marketplaces since October 1, thanks to the Affordable Care Act,” proclaimed a Thursday blog post written by Centers for Medicare & Medicaid Services Administrator Marilyn Tavenner.
For months, fears circulated that the glitch-riddled rollout of the insurance exchange system, the cornerstone provision of the Affordable Care Act, would prevent enrollments in marketplace-based plans from reaching the Obama administration’s target by March 31, the end of the six-month enrollment period. Hitting this milestone is important for both the administration and for the success of the overall healthcare reform. It gives the White House strong evidence that the law has made significant inroads into making health coverage available to the country’s nearly 50 million uninsured Americans, which will be key to the Democratic Party’s hopes in the upcoming midterm elections.
Furthermore, experts have said between 5 million and 7 million individuals need to enroll for health insurance coverage via the exchange for the system to work, meaning that only with enrollments of that magnitude will the exchanges have risk pools broad enough to balance out the proportionally higher medical costs of the sicker and older individuals who will likely be among the first to sign up.
Before the October 1 launch of the marketplace system, the nonpartisan Congressional Budget Office calculated that as many as 7 million people would enroll by March 31. But after the federally created online insurance marketplaces launched with software errors and design flaws that for weeks caused hours-long wait times, preventing potential customers from creating accounts and completing the 30-step enrollment process, the CBO lowered the estimate to 6 million.
The administration had more than enough cause for concern. In the final months of last year, administration documents obtained by Republican Rep. Darrell Issa of California showed that in the first day after the federal online marketplaces went live, just six people nationwide had actually enrolled for insurance plans. By the second day, that number had only reached 248.
Those low figures not only spurred Republican criticism but put into question whether the enrollments would reach the administration’s targets. During the series of congressional hearings that followed the troubled exchange rollout, those responsible for overseeing the creation of the reform’s exchanges — including Tavenner and Department of Health and Human Services Secretary Kathleen Sebelius — expressed confidence that enrollment numbers would gain momentum as the signup deadline approached.
Momentum has indeed been gained. Enrollments, which topped 1 million in both December and January, appeared to lose steam in February, with just 800,000 signups coming as of March 18, putting total enrollments at 5 million. But another 1 million Americans signed up for marketplace-based insurance policies since the administration last released its official numbers. In the past few weeks, the White House has enlisted both celebrities and top government officials to encourage uninsured Americans, especially the young and healthy, to sign up for coverage.
Premiums in the new federally facilitated and state-run insurance exchanges were calculated based on the assumption that young, healthy, and therefore cheap-to-insure individuals would be moved into the new marketplaces because the cheaper plans they were currently enrolled in would not comply with Obamacare’s new requirements, or that they were without insurance before.
If those healthier individuals chose not to purchase Obamacare insurance policies, the risk pools of the insurance exchanges would be dominated by older, sicker people, who are more like to find more affordable policies through the exchanges. Exchange risk pools must be broad enough to balance out the proportionally higher medical costs of the sicker and older individuals who will likely be among the first to sign up.
The most recent release from the Centers for Medicare & Medicaid Services gave no indication of how many enrollees were between the ages of 18 and 34 years old, but in the previous reporting, those young adults made up approximately 25 percent of the total. Healthcare experts have calculated thatthe percentage should be closer to 40 percent.
The March 31 deadline has been extended by the administration. Time and time again, the Obama administration has shown itself willing to be flexible with deadlines for the Affordable Care Act’s insurance exchange system. Even though government officials repeatedly called the March 31 enrollment deadline “firm,” the White House will allow additional time to Americans who say they are unable to complete applications for insurance coverage by the cutoff date.
“Open enrollment ends March 31. We are experiencing a surge in demand and are making sure that we will be ready to help consumers who may be in line by the deadline to complete enrollment — either online or over the phone,” Department of Health and Human Services spokeswoman Joanne Peters told CNN. On Monday, the the federal healthcare website, HealthCare.gov, logged 1.1 million visitors, its second-busiest traffic day to date.
The deadline has technically not been altered. Rather, the administration is framing the additional enrollment time as an extension.
President Barack Obama, who was abroad in Italy, held a conference call on Thursday to thank the volunteers who have helped enroll uninsured Americans, White House officials told The New York Times.“The president encouraged the navigators and volunteers to redouble their efforts over the next four days and leave no stone unturned in trying to bring affordable health coverage to as many Americans as possible,” they said, describing the call.
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