The Patient Protection and Affordable Care Act has endured criticism and challenges from politicians, consumers and providers since President Barack Obama first signed it into action in 2010. Now, as the eve of Nov. 15 is just days away, the start date of the second open enrollment period of the PPACA insurance exchanges, new data shows projected rates of enrollment have significantly dropped.
According to the latest HHS projections released on Nov. 10, enrollment in 2015 will be between 9 million and 9.9 million people, falling drastically short of the 13 million people the Congressional Budget Office projected in April would enroll.
A variety of factors could account for fewer enrollees, with shifting attitudes regarding the costs, access to physicians and general knowledge of exchange logistics among the most influential. The following list of facts and observations on the climate of the PPACA exchanges can shed some light on the why the enrollment numbers are expected to drop.
1. The number of enrollees could fall in part because of people getting kicked off their plans for signing up for coverage but never paying their premiums. Another explanation could be that former enrollees obtained coverage through other sources, such as through their employers.
2. Despite the fact that one of the main goals of the PPACA is to provide insurance to the uninsured, many uninsured Americans don't know essential information about how to get coverage through open enrollment. According to a Kaiser Health Tracking Poll, last month, 76 percent of the uninsured were unaware of the start date of the federal exchanges. Ten percent thought the next sign-up period began in 2015 or later, and 66 percent reported they know little or nothing about the exchanges. Twenty-one percent of the uninsured who indicated they plan on getting insurance don't know how they will obtain it.
3. According to Drew Altman, president and CEO of the Kaiser Family Foundation, one of the main challenges for the PPACA exchanges that could impact rates of enrollment is awareness about affordability. Many of the remaining uninsured believe they can't afford coverage and aren't sure if they qualify for financial assistance in the form of subsidies. Another challenge that could prevent enrollment from reaching its full potential is securing adequate personal assistance. According to Mr. Altman, personal assistance was crucial to getting uninsured people signed up for coverage during the first enrollment period. This was especially true among those who had never had insurance or hadn't been insured for a long time, those who had language barriers or were worried about family members' immigration status.
4. Consumers' concerns over the cost of coverage are substantiated with recent findings from a RAND study that revealed if subsidies under the PPACA were eliminated, many consumers would be unable to afford coverage without financial assistance, resulting in a 70 percent enrollment drop. PPACA subsidies are hotly debated, with two appellate courts recently issuing conflicting decisions on whether subsidies to help pay for insurance plans are available in all states, including those that did not set up their own health insurance exchanges.
5. Since Healthcare.gov opened for window shopping on Sunday, consumers have been able to start comparing health policies sold on the federal exchange. According to The Fiscal Times, premiums tend to be lower in urban areas, and people in rural areas might see higher price increases from last year. Josh Archambault, director of healthcare policy and program manager for the Middle Cities Initiative at the Pioneer Institute told The Fiscal Times, "Most insurers have been changing their insurance plan designs dramatically under the federal law. Narrow networks, higher deductibles and higher out of pocket costs when you visit a doctor are the new norm… In other words, for many Americans under Obamacare, they are paying more and getting less."
An October survey revealed two-thirds of Americans insured under the PPACA plan to switch healthcare plans within the federal exchanges in 2015, though only 20 percent cited dissatisfaction with their plan as their reason to switch. Out of those who intend to shop around for coverage in 2015, top motivators are lower costs and improved access to physicians.