CBO slashes expectations for ACA sign-ups

For the last few years, millions of Americans have flocked to state- and federally-run health insurance exchange websites, and that number has been growing steadily at the start of each new year. However, it now seems as though the number of sign-ups that was initially expected for 2016 will not be met, according to a nonpartisan government agency.

The Congressional Budget Office recently announced revised predictions for health insurance sign-ups via the Healthcare.gov insurance exchange websites, bringing them down to an expected 13 million for the 2016 open enrollment period, according to a report from the Associated Press. Originally, that prediction was set at 21 million, so this marks a likely decline of about 38.1 percent. Indeed, that somewhat echoes a similar revision made a few months ago by the U.S. Department of Health and Human Services, which originally projected a number close to the initial CBO guess, but revised that downward by about 10 million.

Many factors could come together to keep millions of consumers without health insurance.

Is that a problem?
The question of whether this constitutes a disappointment is, to some extent, in the eye of the beholder, the report said. For instance, that's well below initial expectations from the CBO, but at the same time, it's more in line with what the Obama administration itself had expected as of a few years ago.

In fact, the 13 million number would actually constitute an improvement over the White House's initial projections, which were for only about 10 million sign-ups through the end of 2016. A 30 percent overreach would likely be quite good news for proponents of the health care law, the report said. Of that 13 million, nearly 85 percent (about 11 million) would receive federal or state subsidies to help them pay the cost of coverage for the insurance they get through Healthcare.gov and state-run equivalents.

Still work to do
However, all of that will still leave millions of Americans without coverage, the report said. This is because a lot of states have flatly refused to expand their internal Medicaid programs for state residents, leaving something of a major gap between the low thresholds needed to qualify for Medicaid, and the higher ones that allow consumers to get into the ACA's exchanges. In addition, though, there are also plenty of Americans who can get onto the health insurance exchanges, but even despite the subsidies for which they are likely to qualify, they still cannot afford health insurance.

Further, the CBO is now warning that it might need to further revise its projections downward, because unforeseen economic difficulties may make it just a little bit harder for people to buy coverage, the report said. That could include a lot of people in states where Medicaid was not expanded, slipping into the coverage gap.

This may, however, present an opportunity for health insurers to do a better job of connecting with people who do not have such coverage, and helping them to find real-life solutions to the very real problems they face. That may be particularly important because of how much the federal fines for going without coverage are going to rise this year.