As Health Markets Struggle, 9% Average Rise in Enrollment Is Predicted

WASHINGTON — The Obama administration said Wednesday that it expected monthly enrollment in the Affordable Care Act marketplace to average 11.4 million next year, up 9 percent from the monthly average this year, despite rising premiums and the departure of major insurers from the marketplace in many places.





Sylvia Mathews Burwell, the secretary of Health and Human Services, also predicted at a news conference that 13.8 million people would sign up for coverage in the fourth annual open enrollment period, which starts Nov. 1 and runs through Jan. 31. That represents an increase of 1.1 million people, or 9 percent, over the number who signed up in the last open enrollment season.

If enrollment increases as the Obama administration predicts, it would suggest that the marketplace is steadier than its critics contend. Federal officials say that subsidies will insulate many consumers from rate increases, and that the prospect of stiffer penalties will induce more people to sign up. In addition, they say they have refined their marketing strategy to attract young, healthy people.

But some of the administration’s previous forecasts have proved overly optimistic. Insurers say they have not seen a big influx of “healthier consumers,” as officials predicted last year.

And Ms. Burwell did not say how many people would be on the rolls at the end of 2017, even though she has treated such year-end enrollment as a significant measure of success in the past. Many people who sign up never activate their insurance or drop it during the year because they fail to pay premiums or just terminate the coverage, in some cases after getting expensive medical treatment.

“We are not moving the goal posts,” said Kathryn E. Martin, an acting assistant secretary of Health and Human Services who helped develop the estimates. “We are just using what we believe is a more meaningful metric.”

Of the 12.7 million people who signed up in the last open enrollment period, which ended Jan. 31, 10.5 million were on the rolls in June, a decline of 17 percent. And the administration expects enrollment to dip further, to 10 million at the end of this year, in keeping with a prediction Ms. Burwell made in October 2015. Federal officials are not making a similar projection for December 2017, saying the monthly numbers fluctuate and are misleading.

Despite the recent problems, Ms. Burwell said she was “confident and excited about the future of the health insurance marketplace.” She said she would “use all the tools we have to build a stronger, more stable marketplace.”

Ms. Burwell’s upbeat message contrasted with the perceptions of many insurers.

In a letter to the Obama administration this month, Alissa Fox, a senior vice president of the Blue Cross and Blue Shield Association, expressed “concern about the future stability of the individual market.”

“Under current rules,” Ms. Fox said, “too many people are buying coverage when they need medical services and dropping it after receiving care. This has resulted in an out-of-balance risk pool, less competition, fewer consumer choices and much higher premiums — all of which pose a serious threat to future market sustainability.”

In an uncharacteristic jab, Ms. Burwell blamed Republicans for the troubles of the marketplace. “At nearly every turn,” she said, “we’ve had to overcome partisan attempts to repeal and undermine the law through legislation and litigation.” Republicans in Congress have voted more than 60 times to repeal all or parts of the law, which was passed in 2010 without any Republican votes.

Ms. Burwell’s announcement came one day before President Obama is scheduled to travel to Florida for a speech on the health care law at Miami Dade College. In a number of tight congressional races, Republicans are running advertisements against the law and Democrats who supported it.

Donald J. Trump, the Republican presidential nominee, wants to repeal what he calls “horrible Obamacare,” and his Democratic opponent, Hillary Clinton, while supporting the law, has proposed substantial changes to reduce health costs for many consumers.

Of the 13.8 million people whom the administration expects to sign up in coming weeks, 3.5 million are uninsured, 9.2 million already have coverage through the insurance exchange and 1.1 million have unsubsidized coverage that they bought outside the exchange. About 85 percent of the people who now have coverage through the exchange receive subsidies to help defray the cost.

After taking account of the subsidies, Ms. Burwell said, “most people shopping on the marketplace will still be able to find a plan for less than $75 a month.”

Ms. Burwell said the expected new sign-ups would “keep driving down the national uninsured rate, which is already the lowest in our nation’s history,” at 8.6 percent early this year.

Rate increases around the country have caused alarm among consumers, state regulators and politicians.

In Pennsylvania, the state insurance commissioner, Teresa D. Miller, a former Obama administration official, announced this week that she had approved rate increases averaging 32.5 percent for individual plans in 2017.

Arizona this week approved increases averaging 51 percent for the state’s dominant insurer, a Blue Cross and Blue Shield company.

Minnesota approved rate increases ranging from 50 percent to 67 percent, to keep insurers in a market that was “on the verge of collapse,” in the words of the state’s top insurance regulator, Commerce Commissioner Mike Rothman.

In Colorado, premiums in the marketplace will be increasing about 20 percent. “There are fewer carriers offering fewer plans on the individual market for the coming year,” the Colorado Insurance Division reported.

Tennessee has approved rate increases averaging 62 percent for BlueCross BlueShield, 46 percent for Cigna and 44 percent for Humana.




Resource : http://www.nytimes.com/2016/10/20/us/politics/affordable-care-act-enrollment-rise-predicted.html

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