Monday, December 2, 2013

CBO's ACA Enrollment Forecast and Current Status

(from CBO Enrollment Forecast)

The above chart is the "holy grail" CBO forecast for Obamacare. Key points:

  • In 2014, 9 million will sign up for expanded Medicaid (this was before 25 states decided to refuse the Medicaid expansion), 7 million will sign up for private insurance on the Exchanges, of which 2 million will come from the prior non group market. Total reduction in uninsured: 14 million.
  • Most everybody on the Exchanges will receive subsidies. Only 1 million out of 7 million will not be subsidized in 2014.
  • Employment-based coverage will stay flat in 2014, drop 2 million in 2015, and a further 6 million in 2016.
  • By the end of 2016, 25 million formerly uninsured will have coverage.
And here's where we are today:

Points to highlight:
  • A straightline extension of the Medicaid number (1.7 million enrolled with 34% of the time gone) would give us 5 million signups by March 31 - right on target, if the nonparticipating states are factored out.
  • Similarly, a straight-line extension for the private insurance signups would give us about 1 million, well under the 7 million target.
So what's your guess? Here's mine:
  • Medicaid - 7.5 million
  • Exchange - 5.0 million
Considering the horrible start, not too bad. Am convinced there will be a big surge at the end that will be handled mostly well by the website's front end and pretty well by the backend (the part that links to the insurance companies). The system will be seen to be working, to be self-correcting, and most experts will be predicting a smooth open enrollment, when October 2014 comes around. Further: employers will not be planning a wholesale dumping of employees into the Exchanges for 2015 and 2015 premiums will be coming in with only small increases over 2014.

If this is the picture next summer, what will the GOP argument be? Mostly unchanged. They will focus on whatever problems are present; they will argue that employers will begin dumping next year, and that premiums will surely start skyrocketing soon, etc.

Will the public begin to see the true picture? I think so, but I'm not sure. It's possible the MSM will start holding the GOP accountable for making predictions that don't pan out, but I won't count on it.

The sleeper might be healthcare costs overall. If they stay moderate for another full year, and more research analysis points to the ACA as a key factor in the cost slowdown, this could tip the analysis towards a conclusion that the ACA is a strong net plus, and that GOP resistance has been political, not based on sound policy estimates. If this is the tenor of the public conversation, the House will be in play.

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