With sign-up season launching this weekend, officials sharply dialed down expectations Monday for the second year of President Barack Obama’s health insurance law.
Health and Human Services Secretary Sylvia M. Burwell said she’s aiming to have 9.1 million paying customers enrolled in 2015 for subsidized private coverage through HealthCare.gov and state insurance markets.
That’s more than now, but well below the 13 million that the Congressional Budget Office had projected.
After a chaotic rollout last year, Obama’s signature program faces an even tougher test this time around. The public remains skeptical and Congress is now fully in the hands of Republicans committed to repeal it.
Until now the congressional numbers have been used as the yardstick for the program’s success, and critics suggested the White House just moved the goal posts.
“People aren’t signing up because they realize it’s not a good deal for them,” said Sen. John Barrasso, R-Wyo., adding that the administration is “spinning the facts about enrollment.”
Burwell said she based her goal on new estimates from number crunchers in her department that between 9 million and 9.9 million paying customers will enroll for 2015. She had requested the estimates after taking office in the spring.
“It’s not about a number,” she said. “I came in and asked the team, let’s analytically build it, and that’s what we did.”
The health insurance exchanges are one part of the law’s two-pronged strategy for helping the uninsured. Together with a Medicaid expansion for low-income people, it has contributed to about 10 million people gaining coverage this year.
HealthCare.gov and state markets allow those who don’t have a health plan on the job to buy taxpayer-subsidized private insurance. Many people are actually required to do so, to avoid fines specified under the law for those who remain uninsured. Open enrollment for next year starts Nov. 15.
At least one independent nonpartisan expert said that either the administration number or the congressional estimate could turn out to be valid.
“An estimate of 9 million enrollees is just as plausible and defensible as an estimate of 13 million,” said Larry Levitt of the Kaiser Family Foundation.
On one hand, said Levitt, the law’s mandate that most Americans get covered or risk fines would argue for a bigger number.
On the other hand, Levitt continued, “there has never been a program as controversial and politically divisive, which could dampen how quickly enrollment grows.”
If fewer people sign up that will mean less taxpayer dollars spent on the program, at least in the short run.
But that would not be welcome news for hospitals, which might see bigger-than-expected numbers of uninsured people.
The administration said it disagrees with congressional number crunchers about how quickly Americans will come to accept the law, believing that more time will be needed.
Officials said they started with the current number of paying customers, which is 7.1 million.
Of these, they estimated 83 percent would re-enroll for 2015, or 5.9 million. Some of the remaining people might become uninsured, but more likely they would pick up coverage through a job as the economy keeps growing, or through another government program.
That would leave a goal of signing up 3 million to 4 million new customers for next year.
Community workers say those people will be harder to convince. Those who sat out last year probably tend to be more skeptical of the program. And even with generous subsidies, some consumers will still struggle to pay their premiums. But fence-sitters be advised: fines for remaining uninsured will go up in 2015.
Separately, the administration also said:
— About 112,000 people who signed up this year but failed to resolve questions about their citizenship or immigration status have lost coverage. Only citizens and legal residents can get health insurance through the exchanges.
— About 120,000 people currently signed up will see their premiums go up Dec. 1 because they did not resolve income questions that affected the size of their subsidies.
Consumers interested in checking out their options can get an early peek at 2015 premiums plans on HealthCare.gov. Window-shopping went live Sunday night.
