The clock is ticking down toward the March 31 deadline for open enrollment in new insurance plans that are the centerpiece of the Affordable Care Act, creating an urgency among U.S. consumers, businesses and government officials.
This month has seen a surge in enrollment—more than 1 million people visited HealthCare.gov on March 24—and an even greater groundswell of demand is expected as March 31 approaches, which could put added pressure on the online marketplaces. Obama administration officials announced this week that extra time would be given to Americans who try to sign up but encounter problems or those who have special or complicated cases, according to various news sources.
The increased demand could be a response to the revved up outreach efforts on the part of state agencies and the Obama administration to sign up the uninsured by March 31.
“We're going to be working hard right up to the deadline to ensure that that information is getting to the people who need it and that more Americans are enrolling,” said White House press secretary Jay Carney in a press briefing on March 19.
The administration has used multiple approaches—radio and television spots and interviews, social media and even the president’s recent appearance on a Funny or Die comedic skit –to spread the word, said White House spokesman Shin Inouye in an e-mailed statement to the AFRO.
In Maryland, health officials have staged a number of enrollment fairs throughout the state. And, in nearby Washington, D.C., officials have used varied approaches, including staging enrollment drives at church concerts and other faith-based activities, hosting a “Happy Hour” enrollment event at a local bar and launching an application for mobile phones.
“It has been a challenge from the start to make sure we were strategic in our attempts to communicate, educate and enroll people,” said Mila Kofman, executive director of DC Health Benefit Exchange Authority. “Our outreach efforts have been multi-targeted and directed to where people live, work, pray and play.”
The fast-approaching enrollment deadline presents different concerns for consumers, businesses and officials.
“If you do not have health insurance already and don't enroll by March 31st, you may not be able to get health insurance again until next year,” said Inouye, about the risk faced by Americans.
There is no enrollment deadline for Medicaid and Children’s Health Insurance Program policies. And, in particular circumstances, such as lost employment, individuals will have a special enrollment period. Otherwise, consumers who do not purchase health insurance could face a tax penalty of $95 or 1 percent of their income—whichever is higher.
For businesses with 50 or more full-time employees, March 31 represents the deadline for offering insurance to their workers—or they face fines of $2,000 to $3,000 per employee under the law.
For state and federal officials, the deadline could represent a day of reckoning when the results of their enrollment efforts—and the millions of taxpayer dollars spent on insurance marketplaces, among other expenditures—will be judged according to official or nonofficial benchmarks.
“From the beginning our benchmarks have been focused on ensuring that every American takes advantage of this opportunity to get quality affordable health insurance,” said Alvarez.
Numerically, according to a Congressional Budget Office estimate released earlier this month, about 6 million Americans were expected to obtain private policies through the exchanges and about 8 million were expected to enroll in Medicaid and the Children’s Health Insurance Program, which was expanded under the ACA.
So far, more than 5 million persons have enrolled in plans through state and federal marketplaces, Alvarez said.
In the District, where there are 35,000 to 36,000 uninsured, 30,000 persons have enrolled via its DC Health Link exchange so far. And, of the 16,000 eligible for Medicaid, 11,000 have been enrolled, Kofman said.
And, in Maryland, 260,000 people was the target for this first enrollment period and, currently, more than 250,000 (including about 200,000 Medicaid enrollees) have signed up, officials said.
There’s been a particular urgency to enroll younger Americans, who comprise a significant portion of the uninsured, to ensure the insurance marketplaces are actuarially sound and prices remain low.
“Health insurance has to have a risk pool and the risk has to be spread out within that pool,” said Mayra E. Alvarez, associate director, Office of Minority Health, U.S. Department of Health and Human Services. “We not only want older, sicker people to have health insurance but we also want to have younger, healthier people in there to balance the risk.”
So far, 27 percent of marketplace sign-ups has been by young adults.
Obamacare supporters hail the enrollment numbers as a good sign. However, according to the CBO, hundreds of thousands more Americans would likely have enrolled were it not for the sometimes catastrophic technical problems encountered in the initial phases of implementing the online insurance exchanges.
For example, in January, thousands of Medicaid- and CHIP-eligible Americans who applied for health insurance through HealthCare.gov were not enrolled due to persistent glitches, creating further confusion and frustration among consumers and officials, who had to scramble to contact those persons and fix the problem.
The IT troubles have provided grist to Republicans and other detractors of the Affordable Care Act, which recently celebrated its four-year anniversary.
In addition to the malfunctioning websites, the ACA has also caused millions to lose their insurance plans, has increased premiums and will cause overburdened businesses to hire fewer workers, Republicans claim.
“It’s been a broken promise, a broken website, lost jobs, lost plans, shrinking paychecks and rising prices,” said Orlando Watson, communications director for Black Media, Republican National Committee, in an e-mailed statement.
“Unfortunately, it won’t get any better as most uninsured Black Americans will be dumped into Medicaid. Also, the added cost to hiring someone will mean employers will hire fewer people and our community will bear the brunt of this.”
Maryland’s exchange has been one of the worst offenders and Republicans have called for a federal investigation. The fixes—hiring a new IT contractor, tripling the size of the call center, boosting staff boosted and creating a special hotline, among other solutions—will add $33 million to the already hefty $261 million-plus price tag for implementing the marketplace (figures based on already appropriated and projected costs from fiscal years 2012 to 2015.)
“The situation in Maryland has been a national embarrassment by any measure…. Hundreds of millions of taxpayers’ dollars are being thrown down a rat hole,” said Dan Bongino, former Secret Service agent, now a Republican candidate of Maryland’s 6th Congressional District. “People need to take off the blinders and realize this is not going to work…. This has been the greatest legislative debacle in my 39 years on the Earth.”
Maryland Health Secretary Dr. Joshua Sharfstein acknowledged the problems and its adverse impact on consumers, but said those are to be expected in the fledgling stages of a complicated IT system and said the enrollment data shows how much “elbow grease” was put into rectifying the problem.
“The IT problem is regrettable but it is also fixable, so we don’t think that reflects a problem with the law itself,” Sharfstein said.
Similarly, economists say while some premiums have increased—reflecting the increased value of the plans—they are much lower than those first proposed by insurance companies. (The ACA allows insurance price regulators to bring down costs.)
“What we started seeing in the fall was that the prices for insurance plans were lower than expected,” said Elise Gould, director of Health Policy Research at the Economic Policy Center.
For a 25 year old in Maryland, for example, the cheapest plan costs $114; for a middle-aged adult it is $260, which is among the lowest rates in the country.
And nationally, “the majority of people without insurance today will be able to find a plan for $100 a month or less,” Inouye said.
Part of those savings come from tax credits for lower- to moderate-income Americans who sign up through the exchanges. In Maryland, for example, about 75 percent of purchasers of new coverage through the Maryland Health Connection could be eligible for tax credits, which can be applied to the monthly cost of premiums.
As for exactly how many people—particularly the previously uninsured—who are now covered, it is hard to say.
For one thing, there are no figures on how many Americans obtained employer-based insurance or who have paid.
The Republican claim that 6 million Americans were booted off their previous insurance plans, resulting in a net loss of insured, is also erroneous, economists and fact checkers say. While millions received notice that their existing plans did not meet the standards set by the ACA, those same notices said they would be seamlessly enrolled in another plan by the same insurance agency, the Washington Post explained in a Jan. 6 analysis. And the White House offered an administrative fix, allowing many of those persons to stay on their existing plan for another year.
Lingering problems with the online exchanges could also blur the numbers.
“It’s too early to figure out the data,” Gould said, “[but] when all the problems with the exchanges settle there would unequivocally be more people insured.”
And that’s one sign that the Affordable Care Act is working, Alvarez added.
“It is absolutely living up to its promises,” she said. “We have more than 5 million people who now have access to quality, affordable health insurance and now have the peace of mind that if something happens to them they can get the services they need. And for the millions of Americans who already had insurance, they now have stronger plans.
“It is a new day for health insurance.”
Maryland: MarylandHealthConnection.gov, or to call 1-¬855-¬642-¬8572
D.C.: DCHealthLink.com, or call (855) 532-5465
Federal: HealthCare.gov, or call 1-800-318-2596 (individuals and families) and 1-800-706-7893 (small businesses)