It’s time to get ready for round two of Obamacare. Open enrollment in PPACA plans runs Nov. 15-Feb. 15, and there’s plenty that’s changed since last year. Here are some things you need to know.
Enrollment numbers, efforts
The Obama administration announced that PPACA had 7.3 million paying enrollees as of mid-August, down from the 8 million figure they announced at the end of enrollment in April.
So far, the administration has made no enrollment targets this year.
Despite the drop in paying enrollees, the administration still has made a great dent in the number of uninsured in the country. Gallup numbers put the uninsured rate at 13.4 percent, the lowest on record, and largely attributable to PPACA.
But the remaining uninsured may be especially hard to reach. According to Kaiser Family Foundation, the remaining uninsureds have been without coverage for years, and experience many barriers to getting it. Lack of awareness is one. According to a survey from theTransamerica Center for Health Studies, for example, nearly half of those who remain uninsured say they still haven’t heard of the individual mandate, the law’s provision requiring them to get health insurance. And 43 percent haven’t heard of the exchanges where they may be eligible to purchase health insurance.
Thousands more consumers who had their non-PPACA compliant plans cancelled may also be shopping for coverage this year.
Other challenges exist as the public is less interested in buying health coverage through the public exchanges during the law’s second enrollment period, with likelihood of consumers buying PPACA plans dropping 19 percentage points from last year, according to a poll by the Morning Consult.
Plus there is a time crunch — the second round of open enrollment lasts only three months, about half the time as last year.
That’s why groups, such as Enroll America — a nonprofit formed in 2011 to get the word out about PPACA — are amping up efforts by hiring more help to reach out to those without health coverage.
HHS also has thrown hundreds of millions of dollars more at enrollment efforts this year.
Last year, the penalty for not having insurance was $95 or 1 percent of household income, whichever was higher.
Those fees increase in year two: Those without insurance face a fine of $325 per person or 2 percent of income, whichever is larger.
Those higher fines might spur more sign-ups, some industry experts say. But at the same time, cost concerns still plague many without coverage. Among consumers still uninsured as of June, nearly 60 percent said they couldn’t afford coverage, according to a recent analysis by the Urban Institute.
The majority of those who enrolled in PPACA plans through the exchanges will be auto-enrolled in the same health plan they selected in 2014 this coming enrollment period, as well as receive the same subsidies, if applicable.
The administration announced the law’s new auto-enrollment feature back in June as a way to simplify the enrollment experience for consumers.
The new option may also alleviate some of the technical difficulties that have plagued HealthCare.gov during the tumultuous first year of enrollment, as well as give the administration a head start on the increasing number of Americans getting coverage under the law.
Consumers who are automatically re-enrolled in PPACA plans will still have the option of changing plans during open enrollment, according to officials. Enrollees also can return to the system to report life changes.
Even if someone is no longer eligible for a subsidy, they will still be auto-enrolled in their current plan, just without a tax credit, HHS says. State-based exchanges may also take this approach, HHS says, or may propose an alternative.
Industry experts warn that consumers need to review their previous plan or else they might face increased costs.
More carriers are jumping on board to join PPACA’s exchange offerings. Nearly 80 new carriers will participate in PPACA’s marketplace this year, increasing the number of participating carriers by 25 percent, federal health officials say. In total, 77 new carriers will offer coverage when open enrollment for PPACA begins Nov. 15.
The 77 new carriers will be joining those that sell plans in 43 states and the District of Columbia where data about insurance participation was available, HHS says.
HealthCare.gov will get the bulk of the new carriers: 57 carriers will join the federal exchange, bringing to the total up to 248 carriers, a 30 percent increase. Meanwhile, the eight state-based exchanges where data is already available will have a total of six more carriers in 2015, a 10 percent net increase over this year.
HHS notes that four states out of the 36 on HealthCare.gov — Indiana, Missouri, New Hampshire and West Virginia — will at least double the number of insurers that sold plans there this year. And 36 states nationally will get at least one new carrier.
Last year, a number of major carriers — including UnitedHealth, the nation’s largest carrier — proceeded with caution onto the exchanges during its first year either limiting participation or not participating at all, for fear the earliest enrollees would be sicker.
UnitedHealth recently said it will participate in about two dozen exchanges in 2015 after selling in just five this year.
HHS says their data “demonstrates that the marketplace is working to increase competition and lower costs for consumers.”
Specifically, the agency says, an increase of one carrier in a rating area is associated with a 4 percent decline in the second-lowest cost silver plan premium, on average. In 2014, consumers in regions with larger numbers of issuers were able to access a wider range of choices.
There’s no guarantee that HealthCare.gov won’t suffer from the same problems and protest it had last year, but there’s now a new face behind the operation.
The administration announced in August that Kevin Counihan, former leader of Connecticut’s exchange, will take the reins of HealthCare.gov in his new role as Marketplace Chief Executive Officer.
“We are building strong teams with the focus and know-how necessary to advance our mission and deliver impact for the people we serve,” HHS Secretary Sylvia Burwell said in late August when announcing the position. “We are committed to instilling ongoing accountability for reaching milestones, measuring results and ensuring a successful open enrollment period.”
According to an HHS statement, in his new role, “Counihan will be responsible and accountable for leading the federal Marketplace, managing relationships with state marketplaces, and running the Center for Consumer Information and Insurance Oversight, which regulates health insurance at the federal level. He will report to CMS Administrator Marilyn Tavenner.”
Counihan has had success in this arena: Connecticut’s state exchange has been one of the most successful in the nation, succeeding enrollment projections. Access Health CT signed up about 79,000 people for coverage through Connecticut’s exchange, while another 120,000 gained Medicaid coverage. Since 2012, the state’s uninsured rate has been cut nearly in half, from 7.9 percent to 4 percent.
Despite some strides made by the Centers for Medicare & Medicaid Services within the last year, a recent report from the Government Accountability Office detailed continued privacy and security weaknesses on HealthCare.gov.
“While CMS has taken steps to protect the security and privacy of data processed and maintained by the complex set of systems and interconnections that support Healthcare.gov, weaknesses remain both in the processes used for managing information security and privacy as well as the technical implementation of IT security controls,” the GAO report says.
Specifically, GAO says, the CMS has not always “required or enforced strong password controls, adequately restricted access to the Internet, consistently implemented software patches, and properly configured an administrative network.”
The GAO also detailed six recommendations for HHS to protect privacy on the federal exchange but it remains to be seen if those issues have been resolved.
Reports over 2015 premium costs have fluctuated wildly. Recent research and approvals, though, has pointed to modest increases in most major markets driven by increased carrier competition.
The question over the legality of PPACA’s subsidies — spurred by two contradictory court rulings in July — is also creating a big unknown in PPACA plans. But with numerous appeals expected in those court decisions, the legality of subsidies shouldn’t play much into this year’s enrollment — at least not yet.