In the aftermath of the passage of the Affordable Care Act in 2010, discussion surfaced on whether the law’s “carrot and stick” approach to get Americans to enroll in health insurance was strong enough to prevent a death spiral in which the majority of enrollees were sick and elderly, causing premiums to sky rocket.
Nearly two enrollment seasons later, the ACA appears to have been successful.
A new report from the Congressional Budget Office reflects a sizeable dent in the number of Americans without health insurance. After this year, an estimated 36 million people under the age of 65 will be uninsured, down from 55 million had the ACA remained unpassed.
The CBO also suggests the number of uninsured will continue to drop, falling to 31 million in 2016 and 20 million in 2017.
That’s mostly due to premium subsidies provided to lower-income Americans and the expansion of the Medicaid program in certain states, the report noted.
Despite the optimistic projections, one potential roadblock has surfaced. An upcoming Supreme Court decision on whether federal subsidies offered to states without their own insurance exchange are legal has the potential to make insurance unaffordable for more than 80% of last year’s ACA enrollees.
Additionally, employer-based coverage is expected to decrease. With little incentive for employer s of fewer than 100 workers to offer coverage, the CBO expects 153 million Americans under 65 will have employer-provided coverage in 2016—7 million fewer than if the ACA had not been passed.
Indeed, employee benefits brokers say interest among small businesses in SHOP—the exchange’s small business portal—has been low.
“There is really no interest among my clients whatsoever,” said Thomas Harte, a broker with Landmark Benefits in Hampstead, N.H. “When they’re looking at SHOP opportunities versus our own private market, there’s really no differential in offerings or price and most clients don’t qualify for tax credits because they’re above the income thresholds.”
The story is not so different in other parts of the country. Just 200,000 people visited the SHOP portion of HealthCare.gov during the first week of the 2015 open enrollment period, compared to the 1.5 million Americans who checked out plans on the individual health exchanges.
