‘PROOF OF CONCEPT’
So far, enrollment has been uneven. About half the states are expanding Medicaid as the law intended, and interest in private insurance lags in more than a dozen states where public leaders oppose Obamacare or have failed to produce a working state-operated marketplace. Consumer costs next year could vary widely, with premiums likely to rise in the double-digit percentages in states with lower enrollment.
“In most of the country, they’ve basically done a proof of concept: It can work. It has not yet succeeded and won’t succeed until you know that most of the uninsured have been covered and the market’s stable, with reasonable growth in premiums,” said Larry Levitt, a health policy expert at the nonpartisan Kaiser Family Foundation.
The nonpartisan Congressional Budget Office estimates that 14 million people will obtain health coverage this year through the private insurance marketplaces or the expansion of the Medicaid program for the poor. However, coverage is not expected to hit its peak of 37 million people until 2018, when the CBO forecasts 25 million people in the marketplaces and 12 million enrolled through Medicaid or its sister health plan, the Children’s Health Insurance Program
Over the next year the administration plans to fully link its enrollment website, HealthCare.gov, with the insurance industry for sign-ups and payments. The administration still has no automated systems for confirming enrollment data, distributing subsidies or compensating insurers for unexpected losses.
There are signs of a last-minute enrollment surge by younger adults for 2014 that could help keep the new online marketplaces viable for insurers. Hospitals and doctor practices are also introducing changes to the way they provide healthcare in line with the law.
“The Affordable Care Act is here to stay. It’s the framework that everybody in the healthcare industry is working within and developing their strategic plans around,” said Dr. Ezekiel Emanuel, who was a top White House adviser on healthcare during the law’s development.
“Even the opposition, the Republicans, recognize the ACA is the law of the land, and despite the rhetoric, actually accept it,” he said.