In Obamacare’s first two years, enrollment reached more than 11.7 million people—surprising skeptics and putting the law on pace to reach its goal of enrolling 21 million Americans in health coverage by 2016.
While this is good news for the administration (and the millions of people who now have health insurance), some experts afraid that Obamacare may soon hit peak enrollment.
They worry that down the road, it might lose momentum and have trouble reaching the most of the uninsured population--especially once everyone who was actively seeking out the coverage has already signed up.
The slowdown in enrollment growth is already occurring in states that fully embraced the law and established their own exchanges the first year.
Margot Sanger-Katz notes in The New York Times Upshot that the first year the marketplaces opened, state exchanges experienced major enrollment gains compared to states using the federal exchange --HealthCare.gov.
This can be explained by the federal portal’s massive technical disaster that crippled enrollment in the first few months of the site’s launch, as well as the local marketing campaigns states with their own exchanges launched to promote the program.
During the second open enrollment period, states relying on the federal exchange seemed to experience substantial enrollment gains, while states that had strong enrollment last year seemed to have only moderate growth this year. California, the poster state for enrollments in year one, increased enrollment in year two by only one percent.
Now, the percentage of eligible people enrolled in the state and federal exchanges are pretty similar, as Sanger-Katz writes, with about 43 percent of eligible people signing up for plans on the federal exchange, compared to 38 percent in the state exchanges. And state exchange enrollment for 2015 was much lower for state marketplaces compared to last year.
Experts are concerned that this could be a trend in the coming years—they worry that enrollment will go down in places where it used to be strong, since the states will have covered everyone that was interested in signing up—while failing to expand their outreach to the remaining uninsured people.
Indeed, awareness of the law and its individual mandate penalty still seem to be somewhat low. The Kaiser Family Foundation reported last week that more than half of all Americans aren’t aware of the penalty for not having health coverage.
This suggests that states and the federal government need to step up their outreach efforts if they don’t want enrollment to go down in the coming years.
“I think the concern about running out of momentum is legitimate,” said Jon Kingsdale, the former executive director of the health exchange in Massachusetts, told The Times. “If we end up running out of gas before 50 percent, that’s very disappointing.”
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