Enrollment in the Affordable Care Act’s public health exchanges, a key effort to reach people without health insurance, will start slowly, a senior Obama administration official said.
While the U.S. exchanges begin selling insurance plans on Oct. 1, the medical coverage doesn’t take effect until Jan. 1, a gap that may lead some Americans to hold off on purchases until the last minute, said the official, who asked not to be identified because the person wasn’t authorized to speak on the record. The biggest portion of sign-ups will occur closer to January, the officials told Bloomberg News today.
Such a scenario would mimic patterns surrounding the initial enrollment periods for Medicare Part D prescription drug plans in late 2005 and Massachusetts’s health-care law in 2006. The Obama administration has said it’s seeking at least 7 million people to enroll through the Affordable Care Act by April.
“A majority of individuals would say, ‘If I’m not going to get my insurance until Jan. 1, then I’m certainly not going to pay my premium on Oct. 1,’” Dan Schuyler, a director at the consulting firm Leavitt Partners in Salt Lake City, said in a telephone interview. “Realistically, a lot of people will not actually buy the product until the end of November at the earliest.”
The $1.4 trillion Affordable Care Act seeks to extend coverage to most of the nation’s 50 million uninsured by expanding state Medicaid programs and creating government-run insurance exchanges, with many people eligible to have their premiums subsidized by taxpayers. About 25 million Americans by 2016 are expected to have gained coverage under the health law, commonly known as Obamacare.
The success of the exchanges probably can’t be judged until December or beyond, said Schuyler, who wasn’t part of the briefing. The initial open-enrollment period runs from Oct. 1 through March 31, 2014.
The Obama administration does expect some glitches with the program, one official said, describing it as still in a testing period. The officials said they are confident people will be able to sign up for plans on Oct. 1 if they want to, despite some technical problems with the websites and coordination between federal and state agencies.
“We should not look at enrollment in October or November as the final measure of what enrollment in the marketplaces will be when the open-enrollment period closes,” said Juliette Cubanski, an associate director of Medicare policy analysis at the Kaiser Family Foundation. “We need to give the outreach campaigns time to take effect, just as they did in ‘Part D.’ People got the message over a period of several months.”
Enrollment in government health programs has traditionally been slow to start. The Children’s Health Insurance Program, which began in 1998, saw 897,000 people enrolled in its first year, Larry Levitt, a senior vice president at the Kaiser Family Foundation, said in a February report published on the website of the Journal of the American Medical Association. Four million children were enrolled within five years.
Medicare’s prescription drug program, known as Part D, also “ran into early problems” that slowed initial enrollment, Levitt wrote. It rebounded and “has operated reasonably smoothly since then,” he said. More than 30 million Medicare beneficiaries are in the drug plans now.
The Obama administration will be able to track the progress of Americans who start to sign up at healthcare.gov, beginning next week, and nudge them with e-mail reminders if they don’t finish the process in October, the officials said. They offered no specific estimate for how many sign-ups they expect.
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