The administration estimates that about 10.5 million uninsured Americans are eligible to sign up for coverage through the marketplaces, but have not enrolled.
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But he said “we are seeing a much longer path” to signing up the rest of the uninsured.
Administration officials and other supporters of the law counter that the slow enrollment growth partially reflects a few of the law’s success.
ASPE developed a range of estimates for the number of individuals who are expected to have Marketplace coverage at the end of 2016 from three sources: 1) individuals who have Marketplace coverage in 2015 and are expected to reenroll in 2016, 2) the QHP-eligible uninsured, and 3) individuals who bought 2015 coverage on the individual market outside the Marketplace and may switch to Marketplace coverage.
The administration has said the coming enrollment period, which begins November 1, will be more challenging than it was those of the last two years. Insurance counselors say they are seeing many people whose subsidies were completely eliminated because of income reporting problems. Then up to almost 4 million uninsured people will select plans during open enrollment.
“As is the case with any well-functioning market, HHS expects to see customers come and go as their life circumstances change”, such as when enrollees drop coverage when they land jobs and become eligible for employment-based coverage, HHS said.
The goal of 10 million sign-ups is far below a Congressional Budget Office projection in June that 20 million people would be signed up in 2016.
The administration projects that by the end of 2016 between 9.4 and 11.4 million people will have coverage. According to Burwell, approximately 40 percent of the uninsured population is living between 139 percent and 250 percent of the poverty level, or $30,000 to $60,000 for a family of four. They tend to be young, managing very tight household budgets, and often unaware they can qualify for taxpayer-financed assistance with their premiums.
More than a third are people of color: about 19 percent are Hispanic, 14 percent are African-American, and 2 percent are Asian.
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Holding them back, Burwell said, are concerns about the cost of coverage and a lack of information about available financial aid, which is set on a sliding scale. She said most of those who remain uninsured are eligible for tax credits, though they’re often confused about them or unaware of them entirely. “About half have less than $100 in savings”.
