Obama ad­min­is­tra­tion low­ers bar for 2016 open en­roll­ment

Modern Healthcare - - THE WEEK AHEAD - —Shan­non Much­more

HHS is pre­dict­ing only a small in­crease in the num­ber of peo­ple sign­ing up for in­sur­ance through Af­ford­able Care Act ex­changes for 2016.

The es­ti­mate of 10 mil­lion en­rolled by the end of the third open-en­roll­ment pe­riod is less than half of what the Con­gres­sional Bud­get Of­fice had pro­jected would be cov­ered for the year.

HHS Sec­re­tary Sylvia Mathews Bur­well called the depart­ment’s es­ti­mate a “strong and rea­son­able goal” for the en­roll­ment pe­riod that runs Nov. 1 to Jan. 31. It is a mod­est in­crease from the 9.1 mil­lion ex­pected to have cov­er­age at the end of this year. Richard Frank, as­sis­tant sec­re­tary for plan­ning and eval­u­a­tion at HHS, said dur­ing a con­fer­ence call with re­porters Thurs­day that the CBO pro­jec­tion of 21 mil­lion en­rollees in 2016 as­sumed sig­nif­i­cantly larger num­bers of peo­ple switch­ing from em­ployer-spon­sored plans to the ex­changes than has oc­curred.

The 2016 goal of 10 mil­lion in­cludes mostly those who are ex­pected to reen­roll in mar­ket­place plans from 2015. About 1 mil­lion now in the non-ex­change in­di­vid­ual mar­ket are pro­jected to switch to the ex­change. The rest would be pre­vi­ously unin­sured Amer­i­cans who qual­ify for ex­change cov­er­age.

The to­tal num­ber of the el­i­gi­ble unin­sured is about 10.5 mil­lion. The 2016 goal calls for sign­ing up about 25% of them.

Bur­well said about 80% of that 10.5 mil­lion would be el­i­gi­ble for financial as­sis­tance, but most don’t know that or mis­un­der­stand how as­sis­tance works.

CMS spokes­woman Lori Lodes said the depart­ment un­der­stands that the re­main­ing unin­sured will be more dif­fi­cult to reach and is de­vel­op­ing di­rected ad­ver­tis­ing and ed­u­ca­tion to try to get them to sign up.

The penalty for not hav­ing in­sur­ance in 2016 jumps to $695 per per­son or 2.5% of house­hold in­come, which­ever is higher. For 2015, the penalty was $325 or 2% of house­hold in­come.


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