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HHS Predicts 13.8 Million Americans Will Enroll in Exchanges

By Erin Mershon, CQ Roll Call

October 19, 2016 -- The Obama administration is predicting 13.8 million Americans will sign up for health insurance during this fall's open enrollment period.

It's a modest goal of about 1.1 million more consumers than they had signed up at the end of the last open enrollment period and, according to estimates released Wednesday, about 3.4 million more than the average enrollment for the first half of this year on the public exchanges set up by the 2010 health law. It's slightly higher than the 1 million additional consumers the agency projected it would sign up during the most recent open enrollment period.

The goal seems more ambitious, however, in the context of the many challenges the marketplaces face this year. Insurance companies across the country are requesting and often receiving premium increases in the double digit, far higher than in years past. In some places, rates will spike by more than 50 percent. Major insurance companies like UnitedHealth Group Inc. and Aetna Inc. are also abandoning the exchanges, citing financial losses. Some small insurers have gone bankrupt or been shut down.

This year's open enrollment period is also shorter. It begins Nov. 1 and closes Jan. 31. Other estimates, too, have projected a slowdown in enrollment. Last week, Standard & Poor projected enrollment would be between 10.6 and 11.2 million people.

But Health and Human Services (HHS) Secretary Sylvia Mathews Burwell is optimistic—based in part on a new analysis from the agency's Assistant Secretary for Planning and Evaluation (ASPE) that shows millions of Americans will qualify for financial assistance if they sign up on the exchanges. About 85 percent of the 10.7 million uninsured Americans who are eligible for exchange coverage are also eligible for subsidies, ASPE said.

"We're confident that millions of Americans will choose to enroll when they learn that quality, affordable health insurance is within reach," she said in a Wednesday speech at the agency. "We believe 13.8 million sign-ups during the upcoming Open Enrollment will help keep driving down the national uninsured rate, which is already the lowest in our nation's history."

Among the 13.8 million people it plans to sign up, the administration is expecting 9.2 million people who currently have coverage to re-enroll. Another 3.5 million of the sign-ups will come from the remaining uninsured. And 1.1 million will come from individuals who are currently in individual plans they purchased somewhere other than or the state-based marketplaces. About 5.1 million people are enrolled off the exchanges, and some 2.5 million of them are eligible for tax credits under the health law, ASPE said.

The administration also declined to share how many people it expects to be enrolled at the end of 2017. In the past, it has projected year-end enrollment—which is lower than initial estimates, as people churn in and out of marketplace coverage or stop paying their premiums. Last year, the agency predicted that 10 million people would still be enrolled at the end of 2016, down from the 12.7 million it initially signed up during that year's open enrollment.

Instead, the administration will now project average monthly effectuated enrollment tallies. Administration officials said the average monthly figure gives a more accurate picture of how many people are actually getting marketplace coverage at a given moment.

Last year, average monthly effectuated enrollment was 10.5 million, slightly more than the 10.4 million average monthly earlier this year.

"We're not moving the goalpost. We're just using what we believe is a more meaningful metric," said Katie Martin, the HHS assistant secretary for planning and evaluation.

Burwell said in her remarks Wednesday there are additional steps Congress could take to shore up the marketplaces, after touting the administration's broader plans to improve its approach to enrollment this year. She called on Congress to make some technical fixes to the 2010 health law, including revisiting the law's multiple definitions of "native American."

She also reiterated her support—shared by President Barack Obama—for a "backstop public option" in areas where "we're having issues in trying to get greater competition." She similarly said she would support increasing subsidies for individuals who aren't currently receiving financial assistance under the law.

The secretary highlighted, too, the importance of finding "tools that we as a nation have to address... the issue of high cost drugs." She pointed specifically to considerations of whether Medicare should be able to negotiate those prices.

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