Waiting for answers on ACA enrollment


By this time, all but a handful of states have wrapped up their initial enrollment period for coverage under the Affordable Care Act (ACA). Now that all the news about website crashes, confusion over plans and guessing over enrollment numbers are more or less over with for the time being, it’s time to answer the question: “What’s next?”

The next open enrollment season begins Nov. 15. That’s less than seven months away. Government agencies, insurers and folks who analyze this stuff for a living are beginning to sift through the data generated from this initial enrollment period. In the weeks and months to come, here are some questions they will need to answer.

1. Who signed up, and who actually paid the premium? Although the Obama administration proclaimed 8 million signed up for coverage, that number does not tell the entire story. The 8 million only includes those who signed up for coverage on the exchanges. It does not those include who purchased coverage with private health plans outside the marketplace.

In addition to the total number of those who signed up for coverage, analysts will be looking at the age groups represented by those who bought coverage. They also will be  examining enrollment numbers from each of the states to see which states exceeded their goals and which states lagged behind.

As InsuranceNewsNet readers know, coverage doesn’t take effect until the premium is paid. So analysts also will be seeing what percentage of those who signed up for health insurance actually paid the first month’s premium.

2.Will the states and the feds revamp the exchanges? Some of the state-operated exchanges – among them Maryland, Minnesota, Oregon and Hawaii – are still experiencing problems and officials in those states are working to address those problems well in advance of the next enrollment period. And it’s a sure bet that Sylvia Mathews Burwell, who is in line to be the next Secretary of Health and Human Services, will be tasked with taking a serious look at the federal exchange. In addition, the 30 or so states that defaulted to the federal government to run their marketplaces will be given another chance to decide whether they want to operate their own exchanges, but they have a limited amount of time to make that determination.

3. What will advisors and navigators do in the meantime? Those who sell health insurance and those who provide information to guide enrollees through the process won’t be taking a vacation over the next few months. Expect to see continued education and outreach activities over the summer months.

4. What will next year’s premium rates be? Insurers will need to begin setting their 2015 rates right away. In doing so, they will be looking at issues such as the ages and health conditions of those who enrolled in coverage, and how enrollees are using their coverage.

5. Are enrollees happy with their coverage, and are they using it? All of the commotion surrounding the ACA implementation will be rather pointless if consumers are dissatisfied with their coverage and they don’t use that coverage for its intended purpose, which is to keep them healthy.

Seven months might seem like a long time, but it will go by quickly. Nobody expects the developments surrounding ACA to take a summer vacation.


Susan Rupe is assistant editor for InsuranceNewsNet. She formerly served as communications director for an insurance agents' association and was an award-winning newspaper reporter and editor. Connect with Susan →

  • Anne Groff

    Great blog. What I find most interesting is the fact that of all the people who signed up half of them did it right before the deadline. And from what I’m hearing from service providers and people themselves, the plans are in many cases not meeting the needs of the patients. Add that the next enrollment group is a group that chose not to enroll this time many because they fall in the gap between subsidy and income levels. If rates go up, how is that going to affect this group. So, my ultimate question, have we actually made strategic moves forward or are we just moving the pieces around the board?

    • ajs1210

      I’d say we’re moving pieces around the board. As a hospital insurance specialist nurse, we’re seeing many “exchange” customers come to our hospital and they’re OON and cannot understand why they have to be transferred to an INN facility and possibly further away. The networks are so tight and small, their choices are very limited. We’ve had a few patients that we are INN for and 2 so far, that I know of, have already had their plans cancelled for non payment, so guess where that leaves us? No reimbursement for services rendered. And that’s fair how?? This pt now is not only on the hook for what they owe us, they also have no insurance coverage again. It’s like a merry-go-round of nightmares.
      The ACA is proving to be nothing more than a pyramid scheme. Pyramid scheme — New recruits (young enrollees) make up the base of the pyramid and provide the funding, that are then given to the earlier recruits (older and sicker enrollees) above them.

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