Senior Obama administration officials specifically cited hospital finances as an area of concern if Republicans repeal and replace the ACA.

Dec. 21—Despite financial and political “headwinds,” the health insurance marketplaces operated by the federal government are on track to increase enrollment by 1.1 million in 2017, federal officials said.

The total of 6.4 million consumers in 39 states who have selected health insurance that provides coverage starting Jan. 1 is 400,000 more than those doing so at a comparable point last year, according to officials from the U.S. Department of Health and Human Services (HHS). The coverage is not activated until enrollees make their first payment, which 13 percent failed to do after the last open enrollment.

“We’re going to keep moving forward, we’re going to finish this open enrollment by trying to enroll more people than ever,” HHS Secretary Sylvia Burwell said on a media call.

The latest figures do not include enrollments from 11 states and Washington, D.C., which operate their own marketplaces. Final 2017 totals for all ACA marketplaces will be determined after open enrollment ends Jan. 31.

Burwell said the enrollment puts the marketplaces created by the Affordable Care Act (ACA) on pace to meet her previous projections that 2017 enrollment will increase by 1.1 million over 2016 sign ups to reach 13.8 million individuals. Those projections ran counter to an October projection by Standard & Poor's Global Ratings that 2017 enrollment will range from 10.2 million to 11.6 million and some more recent doubts by Wall Street analysts.

The increase came despite average premium increases of 25 percent, the departure of many large insurers, and the incoming Trump administration’s plans to repeal and replace the ACA. The increase came soon after release of a projection by the left-leaning Urban Institute that concluded 12 million people could lose coverage in 2019 under repeal. Republicans said they plan a replacement bill to provide similar coverage levels.

“It’s important to reflect that the headwinds have increased,” Burwell said.

Obama administration officials credited the increased sign-ups to the underlying quality of the insurance options.

“As the existing uninsured population learns about the affordability of coverage and the choices of coverage, that really does drive their decision,” said Andy Slavitt, acting administrator of the Centers for Medicare & Medicaid Services. “Certainly they are concerned about losing that coverage, but what draws them to coverage are the same things we’ve already known about.”

The administration said 8.2 million consumers had selected plans during the same period last year—but those figures included automatic reenrollments, which were not included in figures released this week.

Plan selections from Nov. 1 through Dec. 19—the extended deadline to enroll for coverage that begins Jan. 1—were made by 2.05 million new consumers and 4.31 million returning consumers who renewed their coverage. The number of new enrollments dropped from 2.4 million during the same period last year. Burwell blamed the difference on a decrease in the number of people who remain uninsured and are eligible for marketplace coverage, and on the increasingly common tendency of new enrollees to sign up during the latter half of open enrollment.

Slavitt highlighted a 36 percent increase, relative to the last open enrollment, in the number of customers who used mobile devices to select plans.

Continued Open Enrollment

Burwell and Slavitt will leave their positions when the Trump administration takes office—about one week before open enrollment ends. But they expect the rest of open enrollment to continue as scheduled.

“We have done everything we can to make sure that the team, the career staff, the people that are here serving in any administration are ready to carry out and fulfill what it takes to do the open enrollment,” Burwell said. “We stand ready and will work with the new incoming administration to prepare them for that role that they would have.”

Burwell cited concern that repealing the ACA without a replacement plan could cause the individual market to collapse.

“The American people don’t want to go backwards, and they don’t want to gamble with their health care through repeal and delay,” Burwell said, referring to those with serious and chronic health conditions.

That coverage will cost taxpayers nearly $10 billion more in subsidies to cover the cost of rapidly increasing marketplace plans in 2017, according to a recent studyby the Center for Health and Economy.

The Obama administration recently laid plans for the continuation of the marketplaces by issuing a final rule on the 2018 operating standards for the ACA marketplaces in 2018.

Medicaid Concerns

The senior administration officials also spoke out against Republican plans to revamp the ACA’s Medicaid expansion.

Beyond an expectation that repealing the Medicaid expansion would sharply increase the number of uninsured—not factoring in any replacement—repeal also would impact hospital finances. Specifically, the expansion was helping to reduce hospitals’ uncompensated care costs by $7.8 billion.

“And what that means for hospitals—especially rural hospitals across the country—in terms of their bottom line is a very, very important thing,” Burwell said.

Burwell worried that a Medicaid expansion repeal also could impact states’ ability to address the ongoing opioid epidemic.

Republicans have discussed transforming the Medicaid program into a block-grant program, as well as greatly expanding the use of waivers to allow more state variation.

Burwell hailed the Obama administration’s use of waivers, such as the waiver granted to Tennessee this week, to give states more flexibility. Burwell urged the Trump administration to continue to use that process, instead of going with block grants that would allow states to implement any Medicaid design they wanted with their federal funding.  Burwell dinged block grants for not keeping up with health inflation, which forces states to limit eligibility, cut benefits, or take on more funding responsibility.

“Those are some of the reasons we think that is a problematic approach,” Burwell said.

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


Publication Date: Wednesday, December 21, 2016