Obamacare enrollment must double this year to meet budget goals

Obamacare enrollment must double this year to meet budget goals

Rick Moran

Enrollment in Obamacare insurance plans must double over the next year if budget projections by the Congressional Budget Office are to be met.

An article in the Washington Times shows enrollment lagging far behind original estimates of where the program should be by 2016, and this will have unknown effects on the trillion dollar projection for the program's cost by 2020.

As of June, the Department of Health and Human Services counted 9.9 million customers who have bought plans through the federal HealthCare.gov portal and a handful of state-run exchanges.

That puts the administration ahead of it's own estimates for 2015, but is less than half what the Congressional Budget Officeprojected for 2016, showing just how much work officials have ahead of them as the next round of enrollment begins in less than two months.

Note: HHS revised those numbers downward 3 times between 2012 and 2015, deliberately lowballing the estimates so they could crow about achieving their goal. 

"The substantial increase in penalties under the individual mandate next year is a big wild card," said Larry Levitt, a senior vice president at the Kaiser Family Foundation, a nonpartisan health policy organization. "We're in unchartered territory here about how effective these bigger penalties will be in nudging people to get insured."

"The marketplaces are working," Mr. Levitt added, "but higher enrollment would both improve the insurance risk pool and reduce the number of Americans uninsured."

The individual mandate was included in the Affordable Care Act of 2010 to make sure enough healthy Americans signed up, spreading out the costs for higher-risk customers.

A divided U.S. Supreme Court upheld the mandate in 2012 as an appropriate use of Congress' taxing power.

But congressional Republicans are still intent on scrapping the health care law, and may use a fast-track budget procedure known as "reconciliation" to take a swing at it.

GOP leaders say they may not be able to eviscerate the law through the budget, but Brendan Buck, a spokesman for House Ways and Means Committee Chairman Rep. Paul Ryan, said repealing the individual mandate is "definitely on the table."

"This law is only being held together by mandates and coercion, and that's why we continue to look at ways to repeal the mandates and give people more freedom and choices," Mr. Buck said.

Even as it struggles to meet the 2016 enrollment projection, the Obama administration is on track on other measures, including a CBO estimate that 17 million fewer people lack insurance this year because of the health care law.

As expected, Obamacare premiums have massively increased from last year. The reason is simple: The majority of people signing up for health insurance under Obamacare are older, sicker, and less able to afford it - just as many predicted before the law was even passed. Even with generous reimbursements by the government for industry losses, the companies on Obamacare exchanges felt it necessary to ratchet up premiums:

At a July town hall in Nashville, Tenn., President Barack Obama played down fears of a spike in health insurance premiums in his signature health law's third year.

"My expectation is that they'll come in significantly lower than what's being requested," he said, saying Tennesseans had to work to ensure the state's insurance commissioner "does their job in not just passively reviewing the rates, but really asking, 'OK, what is it that you are looking for here? Why would you need very high premiums?'"

That commissioner, Julie Mix McPeak, answered on Friday by greenlighting the full 36.3% increase sought by the biggest health plan in the state, BlueCross BlueShield of Tennessee. She said the insurer demonstrated the hefty increase for 2016 was needed to cover higher-than-expected claims from sick people who signed up for individual policies in the first two years of the Affordable Care Act.

Several regulators around the country agree with her, and have approved all or most of the big premium increases sought by the largest health plans in their states for the new sign-up season that begins Nov. 1.

Not all states have made their rate decisions, and some have approved relatively modest increases. A number of the states with lower average increases this year had higher rates to begin with. Some also fared better with enrollment under the law. Insurance premiums vary from state to state, for a number of reasons including regional disparities in the costs of care.

When the rate increases were first proposed last summer, Obamacare supporters rushed to defend the program, saying that those increases had to be approved by state regulators and that the final increases would be much more modest.

Guess what...they were wrong.

So now we have a marketplace where insurance coverage, even with a subsidy, becomes too expensive for millions of Americans. This results in fewer signups for Obamacare insurance, fewer healthy people in the risk pool, and the subsequent rise in premiums that will drive more people out of the Obamacare marketplace.

Can you say "death spiral"?