The health insurance marketplaces created under the Affordable Care Act are now in their second year of insuring consumers. While there continue to be some glitches, there are more insured Americans — some possibly for the first time in their life.
Almost 8.84 million people have signed up for Affordable Care Act qualified plans through Healthcare.gov, and 53 percent of these are newly enrolled in 2015. An additional 2.8 million people have signed up for marketplace plans in states operating their own health insurance exchanges.
The official enrollment period for 2015 came to a close Feb. 15, so this is a good time for a status review. Here is a look at eight things we know:
1. The 2015 enrollment period was extended for approximately 150,000 people who didn't understand or were confused by the deadline. The extra enrollment period ran from March 15 to April 30, and it provided an additional opportunity to avoid most of the fee for 2015. Those qualifying for the extra enrollment period ...
- paid the fee with their 2014 federal income tax for not having health insurance in 2014
- were not currently enrolled in coverage through the health insurance marketplace for 2015
- were confused (or didn't know) about open enrollment dates for 2015 and needed another opportunity to enroll in coverage for the remainder of 2015
2. Those who still don't have a plan for 2015 will owe the fee for the months they don't have coverage or an exemption. It is estimated that 3 to 6 million people could face a penalty this year and some of these will pay the fine by choice.
3. About half of those with individual health insurance plans are still buying off-marketplace coverage, even though it may be more expensive. Some desire a broader network of providers than what is offered by marketplace plans or are more comfortable with the plans they have been purchasing prior to the Affordable Care Act. Others simply object to "Obamacare" and will continue to purchase off-marketplace plans in protest.
4. However, many of those with off-marketplace plans are at the 400 percent poverty level and employees caught in the "family glitch" of marketplace plans — and cannot afford family coverage. These are families with access to employer coverage costing less than 9.5 percent of employee-only income. They can't get subsidies on the health insurance marketplace, even though they would have qualified for cost assistance without access to the employer-sponsored plan.
5. Stories of Healthcare.gov and state marketplaces experiencing glitches in their websites continue. The states of Oregon and Hawaii have gotten to the point of shutting down their state health insurance marketplaces. Other states, like California, now realize they will enroll fewer people than originally expected.
6. As of November 2014, small businesses with 50 employees or fewer can offer Small Business Health Options Program (SHOP) plans to their employees.
7. While one of the goals of Obamacare was to reduce the expensive usage of emergency visits, yet three-fourths of emergency physicians polled say they have seen an increase in ER visits. The reason — not surprising to some in healthcare — is that there simply aren't enough primary care physicians to handle all the newly insured patients. Delays in getting appointments cause patients to seek care where they can get it, and this usually means in their local emergency room.
8. Those who have been covered by employer-sponsored plans, have probably started to notice increase in their share of costs. Some of this cost shifting could be expected and is most likely due to the participating health insurance companies re-balancing their offerings and portfolios, because at the end of the day, someone need to pay for this broader coverage.
The rollout of the Accountable Care Act is a process, and it will continue to evolve. Fees will continually increase and the enrollment windows will shorten now that many consumers are established on these plans. Ongoing refinement can be expected as those we entrust with insuring more Americans continually make improvements.
