The Department of Health and Human Services just released the 2016 enrollment numbers for the Affordable Care Act, and the results are good news for supporters of the President’s signature health care law: the third enrollment season brought in nearly 13 million sign-ups for Obamacare, exceeding the government’s goals for enrollment and beating last year’s tally by a margin of almost 10 percent. The new figures, which add to a strong body of evidence showing the continued success of the Affordable Care Act, are likely to present a major problem for Republican candidates campaigning on the promise of repealing it.
According to U.S. Health and Human Services Secretary Sylvia Burwell, approximately 12.7 million people enrolled in private insurance plans through through the Affordable Care Act’s marketplace exchanges during open enrollment for 2016, which ran from Nov. 1 through last Sunday. That’s one million people more than the 11.7 million people who selected plans by the close of open enrollment in February 2015 — an increase of 8.5 percent. And that figure doesn’t even touch on the millions of low-income Americans who received coverage through Obamacare’s expansion of Medicaid.
“Open enrollment for 2016 is over and we are happy to report it was a success,” Sec. Burwell said in a statement released Thursday. “It’s clear that marketplace coverage is a product that people do want and need.”
Going into the open-enrollment period, the Obama administration projected totals between 11 million and 14 million, and yesterday’s announcement put the actual figure above the midpoint of that range. Sec. Burwell said the enrollment totals for this year “exceeded expectations“.
Enrollment statistics bode well for the future
Most of the plan selections were for people in the 38 states — more than 9.6 million — who used the federal website, HealthCare.gov. The other 3.1 million people were enrolled in states that run their own marketplaces. Sec. Burwell said she was pleased to see that four million of the people signing up through HealthCare.gov were new to the federal insurance marketplace in 2016. This, she said, indicates that consumer interest and needs remain high, which is good news for the future of the marketplace.
Of note, approximately 2.7 million enrollees, or about 20 percent of all sign-ups, were in the 18 to 34 age-group, and the percentage of new customers in that age range is higher than last year. Young, healthy people are considered key to establishing a well-balanced market, which translates to lower costs for consumers and a more stable system overall.
Sec. Burwell also noted that about 70 percent of existing HealthCare.gov customers actively shopped and selected a plan for 2016, instead of passively accepting re-enrollment in their 2015 plan. Last year, about 50 percent of customers actively enrolled. Officials have urged customers to actively shop because of the opportunity to pick a plan that may be more affordable, and also because the amount of subsidies that people receive can change considerably as a result of changes in the price of certain so-called “benchmark” health plans sold on the exchanges. More consumer engagement in the process is another positive indicator of performance, said Sec. Burwell, as it shows that people are using their insurance coverage and understanding the value of being insured, and want to continue realizing and maximizing those benefits.
“Marketplace consumers are educated about their options, serious about finding the right plan, and satisfied with the coverage they get,” Sec. Burwell said. “They rely on the Marketplace, and we trust that they will continue to come back, shop and purchase plans in the future.”
Measures of success
The 2016 enrollment statistics are just one measure of the Affordable Care Act’s continued success. Other notable achievements of the law include impressive results on premiums and customer satisfaction rates; the lowest increase in health care spending in 50 years; the growing number of insurers who want to participate in exchange marketplaces; the reduced financial stress on families; the efficacy of the medical-loss ratio; and the improvements in patient safety that have reduced medical errors system-wide.
Perhaps most importantly, when measured by its performance extending health insurance coverage to those who were previously uninsured, Obamacare is clearly working. Since the Affordable Care Act’s coverage expansions took effect at the beginning of 2014, the U.S. has seen a historic 35 percent drop in the uninsured rate. More than 17 million uninsured people have gained coverage under the health law through the new public marketplaces, the expansion of Medicaid and the opportunity for young adults to stay on their parents’ insurance plans until age 26 (and some policy experts estimate that Obamacare has actually added upwards of 23 million previously-uninsured people to the insurance pool). Today, more than 90 percent of Americans have health insurance — the highest rate in our country’s history.
The Affordable Care Act has also drastically reduced the number of underinsured Americans by offering plans with higher benefit standards and more robust financial protections than the individual policies in the pre-Obamacare market, which were often so skimpy as to offer little financial protection for Americans who got sick. That was a system wherein three-quarters of all medical bankruptcies happened to people who had health insurance but were underinsured — i.e., the coverage they had failed to protect them from unaffordable out-of-pocket costs or applied caps on care.
Among other things, the Affordable Care Act prevents insurers from charging higher rates for people with pre-existing conditions or setting life-time caps on coverage, or different rates for women then men. Additionally, Obamacare requires that insurance plans cover a slew of essential health benefits, including mammograms, contraception and other preventative care, at no additional out-of-pocket cost — and those provisions apply to all insurance plans, not just those purchased on Healthcare.gov and other government exchanges. The contraceptive benefit alone saved women almost half a billion dollars in the first year of implementation, or about $269 for each woman who filled an annual birth control prescription.
With three successful enrollment seasons, millions of newly-insured Americans, and millions more benefiting from the new provisions and consumer protections established by the Affordable Care Act, the politics of health care reform have shifted considerably since the 2014 and 2012 election cycles. In those election cycles, Republicans were able to get away with campaigning on a pledge to repeal Obamacare because at that point, they were still campaigning against the idea of Obamacare. Now that people actually have insurance through Obamacare and are realizing its benefits, “Republicans running in this year’s elections may find it harder to deliver on their promise of repeal,” NBC News pointed out, “while Democrats may yet be able to tap the newly insured as a voting constituency.”
While Obamacare remains politically contentious, these latest enrollment figures confirm something very important: that the Affordable Care Act is reaching a critical mass of users and people who know them. Historically, the success of policies and political initiatives has often hinged on how many Americans personally know people affected by an issue, as we recently saw with gay rights and the legalization of same-sex marriage. With millions benefiting from health care reform, repealing the law would result in taking away something tangible for a large and growing group of voters, including:
- 7.8 million young people (19 to 26 years-old) who have stayed on their parents’ plans who would not have been eligible to do so before the Affordable Care Act was implemented. By 2014, the health care law’s provision allowing young adults to remain on their parents’ plans through age 26 had reduced the uninsured rate in this age group by 40 percent.
- Up to 129 million Americans under age 65 with preexisting conditions, including up to 17 million children, who are no longer at risk of being denied coverage because of their health. Before Obamacare, insurance companies routinely denied coverage to people with preexisting conditions or charged exorbitant rates to cover them; studies have found that over a third of Americans who tried purchasing individual insurance plans encountered these discriminatory practices. However, insurers are no longer allowed to engage in such practices thanks to the Affordable Care Act, which prohibits discrimination based on preexisting health conditions. This guaranteed coverage has been a life-changing benefit for many people, especially for older Americans struggling to find work but too young for Medicare.
- 45 million women who have gained access to birth control without a co-pay.
- 12 million people with incomes below or slightly above the federal poverty level who have gained coverage due to the Affordable Care Act’s expansion of Medicaid, the federal insurance program for poor and low-income people, and the Children’s Health Insurance Program (CHIP).
- 3 million additional people with incomes below or slightly above the federal poverty level who would be eligible for Medicaid if all states implemented the expansion. Thirty states have adopted it in some form, and four more are considering it. Notably, the only states that have refused the expansion are states led by Republicans.
- 62 million Americans who now have mental health and substance use disorder benefits protected under federal parity laws.
- More than 17 million Americans who would be uninsured without the Affordable Care Act.
Is the GOP foolish enough to ignore these numbers and actually try to repeal Obamacare? Possibly. And that’s all the more reason why we shouldn’t be foolish enough to put a Republican in the White House.