Feb. 18—Enrollment through public health insurance exchanges and Medicaid authorized by the 2010 healthcare overhaul will fall far short of its 16 million-enrollee goal, according to 2014 projections from a national healthcare consulting firm.

The projection by Avalere Health is that in 2014, 5 million beneficiaries will enroll in an expanded Medicaid program and 5 million will sign up for private coverage offered through a government-run exchange, both of which were authorized by the Affordable Care Act—short of the Obama administration’s enrollment goals.

The enrollment projections—part of Avalere’s 2014 healthcare industry outlook—followed an early February analysis by Avalere that concluded only 1 to 2 million new beneficiaries had signed up at that point for Medicaid. Those totals ran counter to the administration linking 6.3 million Medicaid enrollments since October 2013 to the law. In both its previous study and its industry outlook, Avalere stated that the difference is due to the inaccurate inclusion of both Medicaid enrollment renewals and the so-called woodwork effect of sign ups by previously eligible residents in the numbers publicized by the Obama administration.

Avalere blamed the shortfall in expected exchange enrollees on the widespread technological failings of the federal and state websites. Medicaid enrollments would fall so short, said Caroline Pearson, vice president of health reform at Avalere, because the consultancy calculated the expansion differently than the Congressional Budget Office (CBO), which was the source of the administration’s projections.

For instance, although CBO tried to account for the refusal by half of the states to expand eligibility, Avalere analyzed the likely expansion population in each state instead of assuming two-thirds of possible enrollees lived in expansion states.

CBO recently lowered its 2014 sign-up estimate for both Medicaid and the exchanges by a total of 2 million people due to the technological failings.

Avalere hedged that the administration may be able to reach its goal of 7 million exchange sign ups by extending the March 31 enrollment deadline, a move which administration officials have rejected due to its adverse impact on insurers.

Provider Changes Expected

Other healthcare projections included in the Avalere report included an expectation that the Centers for Medicaid & Medicaid Services (CMS) will amend the Pioneer accountable care organization (ACO) program “to improve its attractiveness for potential participants in its second round and test new approaches to accountable care,” the report stated.

“ACOs will foster population-based risk models that demand a new level of actuarial sophistication,” the Avalere report stated. “Health systems have previously been immune to these demands.”

Additionally, Avalere predicted healthcare price transparency will continue to gain momentum in 2014, spurred in part by the release of charge data by CMS.


Rich Daly is a senior writer/editor in HFMA’s Washington, D.C., office. Follow Rich on Twitter @rdalyhealthcare.


Publication Date: Tuesday, February 18, 2014