WASHINGTON – The Obama administration has substantially cut estimates of how many people will sign up for insurance coverage in 2015 through the federal health law, projecting millions fewer consumers will use new marketplaces created by the Affordable Care Act.
Instead of 13 million customers in the second year of the marketplaces, the Department of Health and Human Services now says that between 9 million and 9.9 million people likely will get coverage.
Today, about 7.1 million people have health plans through the marketplaces, according to the federal agency.
Administration officials said the downward adjustment reflects a more realistic assessment of how quickly a new insurance program like the law’s marketplaces can ramp up. And they noted that the dramatic reductions in the number of uninsured Americans are the most important metric for assessing the law.
“The Affordable Care Act is achieving its central aim: Millions of Americans who were uninsured before now have access to affordable, high-quality health care,” the health agency noted in a memo explaining the new enrollment estimates.
Surveys suggest that about 8 million to 10 million uninsured people have gained coverage this year since the marketplaces opened and since Medicaid was expanded in many states under the law.
Nevertheless, with the marketplaces about to reopen for a second enrollment period, the lowered expectations are certain to draw criticism from opponents that the Obama administration is playing politics with numbers.
The law this year allowed Americans who don’t get health benefits at work to shop among plans on new state-based marketplaces.
Consumers making less than four times the federal poverty level – or about $94,000 for a family of four – qualify for subsidies.
Total enrollment in the marketplaces, though an imprecise metric, has been watched closely as sustained growth is considered vital to reducing the number of uninsured and keeping premiums in check by getting healthier Americans into the market.
By most measures, the marketplaces’ first year has been a success, with enrollment surpassing the Congressional Budget Office’s 2014 estimate of 6 million and new insurers joining the marketplaces for 2015.
The marketplaces beat the estimate even though close to 1 million people who signed up for health plans earlier this year have dropped coverage because they didn’t pay, found coverage elsewhere or were deemed ineligible.
On Monday, administration officials said they had completed the process of terminating coverage for customers with unresolved immigration issues, which resulted in some 112,000 people losing their plans in federally run marketplace.
The nonpartisan Congressional Budget Office, which policymakers rely on to assess the effect of legislation, has estimated that 13 million people would enroll in the marketplaces in 2015.
The budget office projected 24 million would enroll in 2016, and 25 million every year thereafter.
The swift ramp-up in enrollment has long made supporters of the law anxious. Technological issues, though far less severe than last year, continue to plague the enrollment system.
At the same time, the second enrollment period, which is slated to open Saturday, is only three months, half as long as the first enrollment period.
Speaking with reporters Monday, administration officials acknowledged the challenges of signing up so many new people on the marketplaces in 2015.
But they said the lower enrollment figure takes into account other factors, as well.
There has been no major shift away from employer coverage, the officials said, meaning more people remain in health plans provided by their employer.
Many Americans who don’t get insurance from an employer continue to purchase coverage directly from insurers, rather than using the marketplaces.
Renewal rates in the commercial insurance market are only about 80 percent to 85 percent, suggesting that only about 6 million customers who get coverage on the marketplaces will likely come back next year. Administration officials said they expect most of these will get coverage elsewhere, rather than going uninsured.
Finally, officials noted that previous major coverage expansions have taken more than three years.
“The evidence from the Children’s Health Insurance Program and early Medicaid expansions under the Affordable Care Act suggest that the long-run steady state may not be achieved for as much as five years,” HHS notes in its memo.
Administration officials would not say what they believe enrollment will be in five years.
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