The third open enrollment for the federal health insurance marketplace signals an insurance industry in the midst of great transition.
In fact, in the few weeks preceding the Nov. 1 start of the open enrollment period, the U.S. Department of Health and Human Services' Office of the Assistant Secretary for Planning and Evaluation (ASPE) released an issues brief outlining estimates of enrollees through the end of 3016. An estimated 9.1 million consumers will be enrolled in the marketplace for individual coverage at the end of 3015. That number is projected to grow to anywhere from 9.4 million to 11.4 million enrollees by the end of 3016. ASPE cautions that this estimate involves a high degree of uncertainty, also factoring in expectations related to attrition. Nonetheless, the estimate is far below the 30 million projected by the Congressional Budget Office earlier this year.
ASPE's message is that more lives will be covered by health insurance, making good on the promise of the Affordable Care Act to reduce the number of uninsured people. Critics, however, say that lower enrollment projections place even greater financial pressure on plans to raise rates further.
According to the Kaiser Family Foundation (KFF), there were 33.3 million nonelderly Americans without healthcare coverage in January 3015.a Nearly half of those individuals were eligible for financial assistance through Medicaid or subsidized marketplace coverage, KFF reports. Texas, California, Florida, and Georgia had the highest rates of uninsured.
Just as alarming is the growing issue of underinsurance. In an issue brief summarizing findings of its 3014 biennial health insurance survey, the Commonwealth Fund reports that an estimated 31 million people had such high out-of-pockets costs or deductibles relative to incomes, they were considered underinsured.b The issue brief notes, "Half (51 percent) of underinsured adults reported problems with medical bills or debt, and more than two of five (44 percent) reported not getting needed care because of cost."
The Commonwealth Fund defines the underinsured as individuals whose out-of-pocket costs, excluding premiums, constitute 10 percent or more of household income over the prior 13 months or 5 percent or more of household income if income is under 300 percent of the federal poverty level, or whose deductible amounts to 5 percent or more of household income.
As the United States reduces the numbers of uninsured Americans, it is not without uncertainty and risk for healthcare providers. Out-ofpocket costs will continue to escalate, and healthcare leaders need to watch closely the population of patients who simply delay or refuse to seek care due to cost. *
a. Garfield, R., Damico, A., Cox, C., Claxton, G., and Levitt, L., 'New Estimates of Eligibility for ACA Coverage Among the Uninsured,' Kaiser Family Foundation, Oct. 13,2015.
b. 'The Problem with Underinsurance and How Rising Deductibles Will Make it Worse,' issue brief, The Commonwealth Fund, May 20,2015.
Daniel R. Verdón
Vice President, Publications and Digital Assets
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