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U.S Department of Health and Human Services Slashes Projections for Marketplace Enrollment Growth

By John Reichard, CQ HealthBeat Editor

November 10, 2014 -- Insurance exchanges, or marketplaces, created under the health law will enroll significantly fewer Americans in the coming years than originally forecast by the Congressional Budget office, the U.S. Department of Health and Human Services said on Monday.

Officials emphasized that their “bottom up” projection of between 9 million and 9.9 million Americans enrolled and paying premiums at the end of 2015 still represents a 25 and 40 percent increase over 2014 totals.

The CBO projected a total of 13 million paying exchange enrollees in 2015, 24 million by the end of 2016, and 25 million thereafter. Officials Monday said they don’t expect to hit the 24 million mark in 2016 and were vague about when they may reach the “steady state” enrollment figure of 25 million.

The lowered projections came as officials touted improvements in the website, now in the late stages of preparations to handle enrollment in 37 states for the health law’s second sign-up period starting Nov. 15.

The site has seen “tremendous improvement” and will be “simpler, faster, and more intuitive” to use, one official said in a telephone press briefing. Visitors to were able as of Sunday night to “window shop” by comparing plans, covered benefits, and provider networks without having to submit an application.

Health and Human Services Secretary Sylvia Mathews Burwell said at a midday appearance that federal officials have performed numerous technical tests over the past five weeks, including some to see how many users can be on at one time and end-to-end testing to make sure that the website’s components work well.

“Open enrollment this year will be a positive experience for the consumer,” she said. However, Burwell noted that renewing existing policyholders’ coverage could pose challenges. “Anytime you do something for the first time, that’s hard and you worry.”

“We will have outage. We will have downtime, but the most important thing we can do about that is make sure we are prepared,” Burwell said. When something goes wrong, “what we need to do is be transparent fast and get it fixed,” she said.

Monday’s enrollment projections were the latest in a series of setbacks for the health law (PL 111-148, PL 111-152). The statute will be the target of repeated attacks once Republicans assume control of both chambers of Congress next year. Its subsidy program and insurance consumer protections could be thrown into chaos if a Supreme Court review of the legality of subsidies under leads to a mid-2015 ruling canceling aid for almost 5 million Americans.

Even officials’ boasts of a much smoother experience were clouded Monday by a Washington Post report saying that the administration has prepared an extensive backup plan if the site functions poorly, and that notices that were supposed to be in hands of existing enrollees by Nov. 1 telling them whether they likely qualified for subsidies had only been mailed to 1 million of the 7 million enrollees by the third week in October.

The White House appears to be banking on its ability to say that the exchanges are outperforming expectations going into the 2016 election season by turning in a total sign-up tally exceeding 9.9 million next year. The exchanges beat CBO’s year one projection of 7 million despite technical glitches and other frustrations, and awareness of the law and its penalties for going without insurance suggest that the 9 million to 9.9 million target will be easy to attain.

But officials say they face tough challenges because the second enrollment period only runs to Feb. 15, compared to last year’s six-month signup window. They also have to process renewals of existing coverage for the first time.

Officials are projecting that 83 percent of the current 7.1 million enrollees will renew their coverage for the 2015 plan year. That means they’ll have to get around 4 million new enrollees to reach the target.

The updated figure takes into account people whose applications had discrepancies that prevented confirming eligibility for enrollment or subsidies based on citizenship and immigration status and their level of income.

At the end of May, 966,000 enrollees submitted citizenship or immigration information on their applications that did not match HHS data, officials said. A total of 1.2 million submitted income information officials couldn’t confirm. After repeated requests for additional data, a total of 112,000 people lost their coverage because they failed to provide the needed information.

Only 120,000 households out of the 1.2 million who submitted income information that couldn’t be confirmed will have subsidies adjusted on Dec . 1.

“These folks are not losing coverage but will see an increase in their costs,” an official said. Officials emphasized that important coverage gains have occurred under the health law despite the lowered projections—a 26 percent drop in the uninsured population after the first year of the law.

Rebecca Adams contributed to this report.

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