- The last day to sign up for 2016 medical coverage during the open enrollment period through the state and federal health insurance exchanges was January 31 and the Department of Health and Human Services (HHS) announced in a press release that a total of 12.7 million have enrolled or been automatically re-enrolled in a health insurance plan.
Consumers signed up for coverage either through the federal HealthCare.gov program or through state health insurance exchanges. In addition to these 12.7 million consumers, approximately 400,000 people enrolled in health coverage through the Basic Health Program on the Minnesota and New York health insurance exchanges over the recent open enrollment period.
The Affordable Care Act led to the creation of Basic Health Programs, which are state-based systems that offer medical insurance to low-income individuals. The results show that approximately 4 million new people have enrolled in health insurance plans through the federal and state marketplaces.
Additionally, 9.6 million people obtained coverage directly through HealthCare.gov and 42 percent of these individuals were completely new to this particular marketplace. This shows that the individual mandate along with the greater need for healthcare coverage in this country is bringing more people to purchase insurance plans.
“Open Enrollment for 2016 is over and we are happy to report it was a success,” U.S. Department of Health and Human Services Secretary Sylvia Burwell said in a public statement. “The Health Insurance Marketplace is changing people’s lives for the better. Across the country, about 12.7 million Americans selected affordable, quality health plans for 2016 coverage, exceeding our goals. That includes over 4 million new consumers in the HealthCare.gov states who signed-up for coverage this year. The Marketplace is growing and getting stronger and the ACA has become a crucial part of healthcare in America.”
The results also show that 60 percent of new enrollees signed up for coverage by January 1, which is an increase from last year’s showing of 40 percent. The data also illustrates that about 70 percent of people who had coverage through the health insurance exchanges in 2015 actively selected new plans for 2016. This is a rise of 20 percent from the results seen in 2015.
Data on the total cost calculator, provider or drug look up capabilities shows that 3.6 million people used these tools. This shows that this type of technology is useful to consumers looking to select the most cost-effective and tailored plan for themselves.
One final point from the HHS press release discusses how young people are also signing up for healthcare coverage through the health insurance exchanges. A total of 2.7 million people ages 18 to 34 have obtained coverage through the state-based insurance marketplaces.
“Marketplace consumers are educated about their options, serious about finding the right plan, and satisfied with the coverage they get. They rely on the Marketplace, and we trust that they will continue to come back, shop and purchase plans in the future,” Burwell wrote in a statement for HHS.
“Signing up 12.7 million people is an incredible undertaking, especially considering the progress we’ve made to bring down the number of uninsured in years past. But it’s worth the work. Because, for many of those 12.7 million, insurance wasn’t something they could count on prior to the Affordable Care Act. So many were shut out because of sicknesses or finances or bad luck…but thanks to the ACA, we’re changing that.”
While the higher percentage of enrollees in the federal health insurance marketplace is a good sign, there are certain obstacles that could be standing in the way of the exchanges. There are several legal challenges that have put pressure on the marketplaces including King v. Burwell, the Budget Reconciliation Bill, and Hotze v. Burwell.
King v. Burwell
In King v. Burwell, the issue at hand was whether providing federal tax subsidies through the health insurance exchanges was legal. If the court had ruled in favor of abolishing the subsidies, low-income individuals in more than 30 states receiving the aid would be negatively impacted.
Last summer, the Supreme Court voted 6 to 3 in favor of upholding the federal tax subsidies available through the health insurance exchanges. Essentially, it was decided that the Affordable Care Act had intended for the subsidies to be offered through both federal and state insurance marketplaces.
“It is implausible that Congress meant the Act to operate in this manner. Congress made the guaranteed issue and community rating requirements applicable in every State in the Nation. But those requirements only work when combined with the coverage requirement and the tax credits. So it stands to reason that Congress meant for those provisions to apply in every State as well,” Chief Justice John Roberts wrote.
Budget Reconciliation Bill
At the end of 2015, the US Senate and the House of Representatives voted in favor of the Budget Reconciliation Bill, which essentially strips away key parts of the Patient Protection and Affordable Care Act. For example, the bill looked to put an end to the federal government’s operation of the exchanges along with the tax subsidies offered through the marketplace.
However, once the Budget Reconciliation Bill hit President Barack Obama’s desk, he vetoed it and allowed the provisions of the Affordable Care Act to continue.
Hotze v. Burwell
In the Hotze v. Burwell case, a Texas physician filed a suit arguing that the individual mandate and the employer mandate in the Affordable Care Act are unconstitutional. This case affects the health coverage opportunities offered through the exchanges, as the individual mandate requires US citizens to obtain coverage or else face a tax penalty. This particular legal challenge is still awaiting further clarification by the Fifth Circuit Court of Appeals.
“In case of the plaintiffs in this case, they were forced to drop the insurance that they had and liked – which violated Obama’s promise that if you like your insurance, you can keep your insurance – and they had a very limited choice of other plans that were much higher in premium cost and did not have the benefits that they wanted but had benefits that they didn’t want,” Jane Orient, M.D., Executive Director at the Association of American Physicians and Surgeons, told HealthPayerIntelligence.com.
“It was a choice between either buying this insurance that you didn’t want – in many cases, it does not include the hospitals or physicians that you liked – or pay $100 per day per employee to the federal government and get nothing in return for it.”
As the Affordable Care Act continues to make ground and more people gain healthcare coverage through the marketplaces, there may still be ongoing legal challenges Obamacare will have to face in the coming years.