Obamacare’s Second Open Enrollment Starts in Two Months — and It Is Going to be Awful

A version of this Health Alert appeared at Forbes.

If there is one thing that the Administration and Democratic candidates have in their favor going into the mid-term elections, it is that election day is November 4, and Obamacare’s second open enrollment begins on November 15. If the dates were flipped, there is little doubt that voters affected by Obamacare would wreak havoc on the politicians who imposed the Rube Goldberg contraption of exchanges on them.

Despite having just tossed another $60 million out the window “to help consumers navigate their health care coverage options in the Health Insurance Marketplace,” the Administration will likely face an even more bemused and disgruntled population of Obamacare “consumers” than it did the first time around.

Obamacare enrollment may already be below the 8.1 million trumpeted by the Administration after the first enrolment season legally closed on March 31 (although it actually closed sometime around the middle of April). Because there are special circumstances (for example, marriage, divorce, or moving to a new state) that allow people to change coverage outside enrollment season, that number has changed.

Unfortunately, the Administration has stopped reporting exchange enrollment, which it used to do monthly. The latest evidence, from Amanda Kowalski of Yale University and the Brookings Institution, is that 13.2 million people were covered in the individual market at the end of June, representing an increase of 4.2 million above the pre-Obamacare trend. This includes both on-exchange and off-exchange coverage.

An increase of 4.2 million is much less impressive than 8.1 million. Jed Graham of Investor’s Business Daily has been following the health insurers’ filings, and sees evidence that exchange enrollment is dropping, probably due to beneficiaries not paying their premiums. Aetna, for example, had 720,000 exchange enrollees on May 20, but only 600,000 at the end of June. It expects to be down to 500,000 by the end of the year. Cigna expects the number of enrollees in the individual market (including exchanges) to drop from 300,000 last month to 280,000 soon.

Some Obamacare supporters fantasize that Obamacare enrollment may be dropping because more people are getting employer-based health benefits. These advocates see a booming economy that is invisible to American workers and employers. Although most of us with full-time jobs have hung on to our health benefits (according to the Kaiser Family Foundation’s latest survey of employers), there are still way too many part-time workers whose hours have been cut back. One major factor in employers’ unwillingness to give part-timers more hours, or hire full-time workers, is the burden of Obamacare.

There are more likely reasons for people to drop out of Obamacare. Healthy people may have paid their premiums for a few months and then decided that there was little value in the narrow plans offered. Sick people may have received treatment and then dropped coverage because they do not need it anymore.

Plus, the Administration is finally getting a grip on enrollees’ eligibility for subsidies, based on income or immigration and citizenship status. That has recently led to bad news for almost half a million Obamacare enrollees, who have been told that they are about to miss the deadline for cleaning up their paperwork. About 115,000 will be dropped at the end of September, if they cannot verify their citizenship or immigration status. Another 363,000 will have their subsidies clawed back, because they have not verified their incomes. Many of these will find the full premiums too high to handle, and drop out.

There is no evidence that the glitches that made the federal and state exchanges such a tragically comic opera last season have been fixed. Consumers whose special circumstances have made them eligible for enrollment report miserable and confusing customer service — even if they do not expect a subsidy! In Washington, DC, an individual has to buy a policy form the exchange (DC Link), whether they can claim a subsidy or not. One DC mom applied on June 4 for coverage for her daughter. As of August 27, it still had not been processed. This mom is a Harvard-educated lawyer who worked as in-house counsel to the Washington Post for 19 years and now works part time for Goldman Sachs. If this woman cannot “navigate” the exchange, what hope is there for a mere mortal?

If Republicans win the Senate in November, Obamacare’s second open enrollment might give them some leverage to “reform the reform”, if not to repeal the whole law in 2015. I think a good first step would be to shut down the exchanges, and let Obamacare beneficiaries buy their policies directly from insurance agents, either in-person or online.

Comments (8)

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  1. Devon Herrick says:

    Many of us assumed that Healthcare.gov would finally have its act together by the second Open Enrollment. But I believe you’re correct that there is nothing to suggest that is the case. People were frustrated during the first Open Enrollment because their coverage was being canceled and the exchange was not working correctly. They may really get steamed this time. Indeed, if after another year even more people have their old policies canceled, and the exchange doesn’t work, it could really tilt the balance of public sentiment against the ACA.

    • Terry says:

      You really make it apaepr really easy with your presentation but I to find this matter to be actually something which I believe I would never understand. It sort of feels too complex and extremely huge for me. I’m looking forward to your next post, I will try to get the hold of it!

  2. Charlie Bond says:

    Good morning John,

    I write as I prepare to head for Dartmouth for a summit on health care and the debt. Any of your fine readers who will be attending are invited to contact me at cb@patientphysicianalliance. org.

    Health care financing will never be fixed so long as there is no cost-based pricing in health care. Underwriting insurance to pay for irrationally priced goods and services is like trying to build a house during an earthquake in a hurricane. Whatever the good intentions–right, left or center–all efforts are sure to fail until the basic economic problem is addressed.

    As I have said on many occasions, to fix our health care system we will have to bar-b-que a lot of sacred cows. Many of those sacred cows have powerful lobbies that support Republicans and Democrats alike. That’s why kicking the old health care football around one more time will not be helpful.

    As patriotic Americans facing a debt crisis of enormous proportions and a health care crisis of even greater proportions, we have to throw the money-changers out and take back our care and our health care economy. The politicians are not likely to lead this charge, so it is up to us–you and me–to recognize that “health policy” should not be crafted in the stone cold marble halls of Washington or even state capitols. Health care begins with us.

    So let’s drop the labels of Republican or Democrat and stop rejoicing in partisan failures or successes. This is neither a football game, nor a boxing match. We are talking about nearly one in five dollars in our economy, and whether our kids and their kids will be the first generations of Americans to inherit a lower standard of living than their parents, just because they will have to pay for our irrational system of caring for the Baby Boom generation. That is not the legacy we should leave them.

    But more importantly, health care is about us–you and me. Your life or the life of someone you love may hang in the balance of the choices we make. It is time to make those choices intelligently and compassionately and prudently. And let’s begin to reform health care together from the grass roots up, not the top down.
    Hope to see many of you in Hanover.

    Charlie Bond

    • Al Baun says:

      Mr. Bond,
      As always, your perspective is like a clear blue sky in the morning. I wish that I had the discipline to set my daggers aside as well.

      I agree that the sentiment should be ‘to improve’ … as opposed to repeal. The tools of Veto and Filibuster will preclude the ACA repeal for many years, so we should get on with basic improvements.

      I anticipate the open enrollment will proceed smoothly this year (except on Fox) and insurers will announce premium cuts … prior … to November 4. John shouldn’t count his Senate seats before the 5th.

      • DoctorSH says:

        To improve our healthcare system and make it more efficient we should start by removing the inefficiencies of government in healthcare.

        That would mean repealing Obamacare in total.
        But it would also mean changing all the coverage mandates that drive up insurance costs from state to state.

        Change the mandates to riders on an insurance plan and change the plans to work similar to life insurance, with 10, 20 or even 30 year terms.

        Have the insurer and the insured work together as a team as opposed to how it is today.

        Lets have healthcare once again be between the healthcare professional and the patient with the insurer far away in the background only involved after the fact for payments.

        ACA was supposed to be about increasing healthcare and decreasing cost.

        It has done neither other than increased Medicaid which is fine, but healthcare and all the bureaucratic costs and corporate industry giveaways will soon break the bank.

        When you get a healthcare professional and a patient to decide and pay, fraud drops drastically as well as costs.

        So this is not partisan, this is real.

        Get the govt out of the middle of healthcare and put them in the background instead.

  3. Don Levit says:

    Good idea about having a long term policy
    That is the goal at NPLH thru our patented Health Matching Insurance
    The benefits grow significantly each month so as people age and are more likely to have claims their defined contribution HMI account grows prefunding ever increasing deductibles with lowering premiums
    We spoke with the commissioner’s assistant at the Texas Dept of Insurance on Monday
    Our approval as a licensed insurer was assured in the next 2 weeks
    Don Levit
    Managing partner
    National Prosperity Life and Health

  4. Charles Johnsen says:

    Cost based pricing was, is, and always will be a failure. The information a maker and a user need to exchange is within a freely agreed to price for each individual transaction at a specific time and place. This automatically becomes a global price as goods and services freely move, unless it is interfered with by nasty government schemes like “cost based pricing.” The trouble starts the moment we decide that everybody everywhere from today to forever must pay exactly the same price while situations, supplies, raw materials, available labor, etc, change for everybody everywhere from today to forever.

  5. Big Truck Joe says:

    I don’t know why there is an assumption that people are still going to sign up in droves at every new re-enrollment period. Those who desperately needed insurance signed up at the first enrollment and those who don’t, will not…maybe ever. And once those healthy Obamacare recipients start paying some of the inordinately high deductibles, they will start dropping off the rolls just as fast as any new customers sign on because there’s no incentive to stay on. You can never make another first impression and Obamacare has left the general public with a BAD first impression which won’t lead to mass future sign ups. My assumption is this is about as good as enrollment is gonna get – unless companies simply stop offering healthcare coverage for employees – which is what the conspiratorialist in me things may have been the plan from the get go. Obamacare is like a Ponzi scheme now with new healthy people needed to fund the sick And poor already signed up.