Obamacare enrollment is almost over. What just happened?


President Barack Obama said in October that HealthCare.gov would be fixed. It eventually was, though it is experiencing problems this morning. (Photo by Mark Wilson/Getty Images)

After six long months of Obamacare enrollment, today’s the final day – sort of – to sign up for a 2014 health plan. Enrollment turned out better than you might have imagined after HealthCare.gov stumbled badly out of the gate, but the overall number doesn’t tell the full story of the Affordable Care Act’s first enrollment period. It will take some more time to assess the first-year performance, but here’s what we know now.

So, who’s actually signed up?

We don’t have the full data yet, but we have some basic numbers. The Obama administration said more than 6 million people and counting have signed up for private plans in the health insurance exchanges, or marketplaces, since Oct. 1. More than 8.9 million have been determined eligible for Medicaid (that includes people re-enrolling and previously eligible) and more than 3 million young adults have stayed on their parents’ health plans during that time.

Six million exchange signups – so, the administration hit its goal?

Not exactly. For starters, the administration says it never set a specific goal, though it did previously adopt the Congressional Budget Office’s earlier estimate that 7 million would enroll in exchanges. The CBO later revised the estimate down to 6 million after technical problems hindered the first two months of enrollment. Further, we don't know how many people have paid their premiums to officially enroll, though estimates suggest anywhere between 80 percent and 85 percent of signups completed the process. Also, enrollment isn’t quite finished – but more on that later.

Has the uninsured rate dropped?

It appears so, but we don't know by how much yet. We have a general sense of how many people have newly enrolled in Medicaid or stayed on their parents' health plans, but we don't know how many of those signing up through the exchanges, or off them, were previously uninsured. Some surveys have provided insight into this question, though. A McKinsey and Co. survey earlier this month found 27 percent of those signing up for exchange coverage were uninsured in the past year. Gallup this month reported that the uninsured rate dropped from 17.1 percent in the last quarter of 2013 to 15.9 percent in the first quarter of 2014.

gallup

Even before all the early enrollment problems, the ACA was never expected to make a big dent in the uninsured rate in 2014. And even when the law fully ramps up, an estimated 26 million to 27 million Americans are still projected to be uninsured.

Are the young people buying this?

They are somewhat, but we have to wait for the final report on March enrollment to know for sure. The administration was originally aiming for people between 18 and 34 years old to account for 40 percent of all enrollees. As of the end of February, they were just 25 percent of signups. There was a huge surge in the last month of enrollment, so we'll have to see if large numbers of young people were waiting for the last minute to enroll.

Also, insurance markets are state-specific. Some states saw a better mix of young people signing up. Obamacare also has some programs built into it to stabilize insurance markets in the law's early years.

Is the Web site working now?

The Web site had been running pretty smoothly since early December, but it ran into some trouble Monday morning when the site was knocked offline for several hours. Aside from this late-hour stumble, HealthCare.gov had held up through some heavy traffic in the final weeks of enrollment, which includes 8.7 million visits in just the past week. Still, some of the state-run exchange Web sites have struggled to recover since their own failed launches. Exchanges in Hawaii, Maryland, Massachusetts, Minnesota, Nevada and Oregon have all battled tech problems, and Maryland looks to be giving up on its Web site in 2015.

I don’t have insurance yet but want it. What do I do?

Today is the last day to sign up for coverage through HealthCare.gov, by phone at 1-800-318-2596, or through an insurer, broker or enrollment aide. If you have problems signing up today, the Obama administration will allow some more time to enroll. After today, if you live in a state with a federal-run exchange, you could go to HealthCare.gov and “attest” that you had problems signing up before March 31. The administration hasn’t said, however, how long it will keep this option available.

If you live in a state that’s running its own exchange, the leeway policy may be different. The District of Columbia's exchange is keeping enrollment open until April 15 for those who say they had trouble signing up earlier.

What's happening in Maryland?

The state's exchange, known as Maryland Health Connection, has had major problems throughout the enrollment period. Things are so bad  that the state is looking to hook up to Connecticut's enrollment platform in 2015. If you're still trying to get insurance in Maryland, the state said it will keep enrollment open beyond today. All you have to do is call 1-800-396-1961 by the end of the day to let the state know you need more time.

So, is enrollment really over today?

Not exactly. There are special enrollment periods for certain hardships or a change in circumstances like the birth of a child or losing your job. Also, enrollment in Medicaid and the small businesses exchanges, or SHOP, is open year-round. Regular enrollment isn’t scheduled to start again until Nov. 15.

If I don’t have insurance, will I get penalized?

You could, but not necessarily. The penalty per person this year is $95 or 1 percent of income, whichever is higher. However, there are exemptions to the mandate for people who earn too little, who would struggle to afford insurance or other reasons. Additionally, the administration has spelled out 14 hardship exemptions in all. The penalty won't actually be assessed until you file your taxes next year, but the Obama administration isn't expected to enforce the mandate all that strongly.

What does this all mean for my insurance rates next year?

They’re going up just as they do every year. It’s not clear yet, though, how much. Insurers will start filing 2015 rates in just a couple of months, and rate increases will depend on a number of factors. Insurers will be working with just a few months of claims from this year, so 2015 rates could also depend on how accurate insurers’ predictions this year turned out to be.

People signed up. Now what?

One of the things to watch is how people now use their insurance and whether they’re satisfied with their plan. There’s been much discussion already about limited care provider choices in 2014 plans, and the administration signaled that health plans must be more expansive next year.

Some with new coverage may be surprised by their cost-sharing responsibilities. Though the ACA limits out-of-pocket expenses, the costs could still be surprising. The average deductible for an entry-level “bronze” plan, for example, is almost $5,100 per individual, up 42 percent from 2013 plans, according to Health Pocket. Meanwhile, people who purchase the highest-value health plan, platinum, will on average see their deductibles fall significantly.

With enrollment ending, does this mean we can stop talking about Obamacare for a while?

No. But why would you ever want to do that?

for a 2014 health plan

Jason Millman covers all things health policy, with a focus on Obamacare implementation. He previously covered health policy for Politico.
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