Why Affordable Care Act Enrollment Numbers Remain Low

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medical-advocacy_171547334The whole nation knew that unveiling the Affordable Care Act would be a process with an unpredictable outcome. Between questions over whether peoples’ old plans would fit the framework of the ACA, to lawsuits debating whether the individual care mandate should be considered a tax or not, to major technological issues hampering enrollment, there simply hasn’t been any normalcy in the process.

Normalcy creates security, and a lack of security – along with a tiny sample size with enrollment procedures – makes it difficult to assess whether it’s working well. This definitely means that putting projections on enrollment numbers is a very difficult task.

While the government can boast that 10 million people who formerly didn’t have health insurance now have it, there are plenty of other numbers that don’t appear to be reflecting positively in the administration’s favor. For instance, there are 41 million people still living without health insurance in America, according to the International Business Times.

Open enrollment is now under way for the second time, and projections expected that the enrollment numbers would not be met – not even by a long shot. Because of the lack of history, there is some debate about why expectations are likely not going to be met.

 

What Was Expected in Terms of Enrollment

The enrollment expectations don’t seem to be solid estimates. The Congressional Budget Office, according to the International Business Times, estimated that 13 million people would be enrolled by the end of the year 2015. The revised expectation is that the current 7.1 million people taking part in the ACA will be joined by about 2 million more, making a total of 9.1 million.

Reuters has an additional story that gives projections all the way to 2017, where the government reportedly expects 25 million people to have signed up for health insurance under the ACA.

In addition, the IBT report contends that some feel the White House is going with a worst-case scenario (or lowballing the expected number) so that in terms of public relations, the public gets an impression that the program is doing better than expected. Yet others have contended that the Affordable Care Act is simply not working and that individual citizens are taking notice of problems and staying away.

California representative Darrell Issa, a prominent Republican, says that the administration is “moving the goalposts” when it comes to the goals and numbers and that Americans are not getting what they were originally promised.

 

So Why the Decline?

The International Business Times notes that this year’s open enrollment period will be centered around Christmas and Hanukkah, a time of year where individuals are extremely busy and not exactly putting their healthcare needs at the top of the list in terms of importance.

medical-advocacy_184778363Also, the article goes on to say that the open enrollment period is only three months, which is down from a six-month period last year.

Joseph Antos, who works for the American Enterprise Institute, is quoted in the IBT story as saying that it’s possible many Americans without insurance simply don’t feel the need to take action and get insurance.

He went on to say that the early enrollment periods when Obamacare was first unveiled were met with excitement from some. The Affordable Care Act had been talked about for many years. In anticipation of finally getting health insurance, when it finally arrived, many people were willing to fight through more of the technological problems and nuances of the system as a whole.

Those technological problems caused a lot of frustration for people looking to sign up for health insurance. It also gave the ACA’s detractors serious ammunition when governmental debates came up, which definitely helped Republicans (mostly against the ACA) gain control of the United States Senate in the 2014 midterm elections.

The success that Republicans had in those elections showed that there is a growth in the anti-ACA train of thought, and if there are people on the fence about whether or not to get insurance, it definitely gives them enough reason to justify holding off.

 

A Non-Mandatory Mandate?

Another possible reason is that there hasn’t exactly been a compelling penalty for those who haven’t signed up. Part of the initial craziness regarding the ACA was the individual coverage mandate that levies a penalty on those who do not have health insurance.

Antos said that nobody has been penalized yet and that means that those who are on the fence regarding signing up haven’t heard any stories about penalties. He added that the penalty is a theory right now and people will not react by signing up until that theory becomes true.

The reason the penalty was waived was because there were massive technical issues with the healthcare.gov website, and it is possible that might happen again this year due to more problems with applicants having their requests stalled on the site.

On top of these issues are all the caveats that exist from the individual mandate if they meet certain criteria.

 

Lack of Knowledge

Yet another issue may be one so simple that it surprises some. According to the Henry J. Kaiser Family Foundation, the general public simply doesn’t know that open enrollment is happening – or they just have bigger concerns.

A poll from the Kaiser Foundation discovered that only eight percent of registered voters identified the Affordable Care Act as the most important issue with their vote and that more than half of those polled state that they are tired of hearing politicians talk about the Affordable Care Act.

medical-advocacy_162136106Open enrollment began on November 15, 2014 and the poll from the Kaiser Foundation found that this fact hasn’t come to the attention of many individuals. Nearly 89 percent of the uninsured people who responded said they were not aware that open enrollment time for the Affordable Care Act began in November. Of that 89 percent, 76 percent said they have no idea when the enrollment period is and 13 percent misidentified it.

As with any complicated government program, too many individuals don’t take the time to learn all the rules and policies, so a large majority is left uneducated on the topic. As a result of frustration and lack of knowledge, matters of health insurance are often left on the back burner.

The Kaiser study found that two-thirds of the uninsured people in the survey said they know “only a little” or “nothing at all” about the healthcare marketplaces on healthcare.gov, which are offered to those who do not get health insurance offered by their employers.

medical-billing-advocate_59611063Just over half (or 53 percent) of uninsured Americans don’t know that the government is offering subsidies to help people who can’t afford insurance on their own. Despite some public relations campaigns to make people aware, that rallying point doesn’t appear to be gaining traction.

To make matters worse, a recent Supreme Court ruling agreed to hear arguments as to whether subsidies should only be granted to citizens in states that participate in the federal marketplace website. There are fourteen states that have their own state-run marketplaces, and there is now major confusion as to whether subsidies can go to those states, too.

People may be weary of seeing increased premiums. Additionally, some people who have health insurance might decide that increases in cost simply make it better for them to pay the penalty (either 1 or 2 percent of their income, depending on the year the penalties begin) rather than staying insured.

There appears to be insufficient incentive for the masses to enroll in an ACA health insurance plan. For now, until penalties become stiffer and apply to more people, enrollment numbers will likely continue to lag.

Filed under: US Healthcare, Resources, Obamacare, Hospital Bill Review, Affordable Care Act

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