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Nearly 13 Million Sign Up for Obamacare Health Insurance
by REUTERS and ASSOCIATED PRESS
About 12.7 million Americans signed up for 2016 health insurance coverage through the government insurance exchanges, surpassing its expectations, U.S. Health and Human Services Secretary Sylvia Burwell said on Thursday.
That means Republicans running in this year's elections may find it harder to deliver on their promise of repeal, while Democrats may yet be able to tap the newly insured as a voting constituency.
"It's not the unequivocal success that Obamacare advocates had hoped for, but also not the disaster that critics thought could make it a talking point on the campaign trail," said Larry Levitt, of the nonpartisan Kaiser Family Foundation.
The government began offering subsidies for individual insurance in 2014 under the Affordable Care Act, often called Obamacare, and charges a penalty to Americans who do not have health insurance.
In 37 states, customers can buy these plans on HealthCare.gov, the federally run website, while the other states and Washington D.C. run their own online exchanges. Enrollment closed on Jan. 31 for 2016.
This year was the third sign-up season, and different challenges emerged. The problem wasn't the HealthCare.gov website, which is faster, more reliable and easier to use. The issues involved the cost of coverage, the motivations of millions of people who remain uninsured, and the complexity of Obama's signature law.
Avalere Health said that based on Thursday's numbers, it expects 2016 year-end enrollment will be about 10.2 million, above President Barack Obama's administration's forecast of 10 million people being covered through the exchanges. Enrollment tends to dwindle over the year. Some people leave for employer coverage while other customers can't keep up with the costs, even with considerable financial help from the government.
More than 14 percent of Americans were uninsured in 2013 before the health care law's big coverage expansion. That share dropped to 9 percent last year, according to the government. More than 16 million people gained coverage from the end of 2013 to the middle of last year.
Insurers have been struggling to make money on the exchanges, where low enrollment has contributed to high per-customer overhead and has made it a riskier business for them.
Medical costs have also been an issue for insurers in 2015, with many reporting that they have booked unsustainable losses on these products. UnitedHealth Group Inc in November said that it may exit the exchanges after 2016.
On HealthCare.gov, about 4 million new customers signed up for plans and another 5.6 million consumers returned to buy insurance again, Burwell told reporters on a call.
In all, about 12.7 million people aged 18 to 34 signed up for the insurance, she said.
Customers who are younger tend to have fewer medical costs and are considered an important factor in creating financial stability for the private health insurers like UnitedHealth, Aetna Inc and Anthem Inc that sell these plans.
Andy Slavitt, who runs the Centers for Medicaid and Medicare Services division of the health department, said that the enrollment numbers had surpassed the mid-point of its projection to have between 11 million and 14.1 million people signed up for 2016 health coverage at this point in the year.
Despite Fears, Affordable Care Act Has Not Uprooted Employer Coverage
By REED ABELSONAPRIL 4, 2016
The Affordable Care Act was aimed mainly at giving people better options for buying health insurance on their own. There were widespread predictions that employers would leap at the chance to drop coverage and send workers to fend for themselves.
But those predictions were largely wrong. Most companies, and particularly large employers, that offered coverage before the law have stayed committed to providing health insurance.
As it turns out, health care remains an important recruitment and retention tool as the labor market has tightened in recent years. Desirable employees still expect health benefits, and companies are responding, new analyses of federal data show.
“We’re more confident than ever that we’ll offer benefits,” said Robert Ihrie Jr., a senior vice president for Lowe’s Companies, the home improvement retailer.
Companies get a sizable federal tax break from providing the insurance. And if they dropped the coverage, many workers would expect the money in their paycheck to increase enough to pay for outside insurance — or would look for a new job.
The reversal in thinking about employer benefits is so stark that even government budget officials are singing an optimistic tune. They lowered the number of people they think will lose coverage because of the health law and now predict employers will remain the source of coverage for a majority of working Americans for the next decade.
The surprise turnaround adds to an emerging consensus about the contentious health law: It has not upturned the core of the country’s health insurance system, even while insuring millions of low-income people.
“The employer-based system is alive and well,” said Jeff Alter, the chief executive of the commercial insurance business for UnitedHealthcare, one of the nation’s largest health insurance companies. Even among critics of the law, including the Republican presidential candidates, there has been virtually no debate about employer coverage.
About 155 million Americans have employer-based health insurance coverage in 2016, according to an analysis released by the Congressional Budget Office last month. The number will fall to 152 million people in 2019, the C.B.O. estimates, but will remain stable through 2026. Slightly more than half of people under 65 will be enrolled in employment-based coverage.
Employers seem to be staying the course even more strongly than they did before the law. The percentage of adults under 65 with employer-based insurance held firm for the last five years after steadily declining since 1999, according to an analysis of federal data released last month by the Kaiser Family Foundation, which closely tracks the health insurance market.
The health plans employees get to choose from also look much the same as before the law went into effect. The industry remains dominated by familiar names, like nonprofit Blue Cross plans or for-profit companies like UnitedHealthcare and Anthem.
“Employer coverage is much more stable than anyone anticipated,” said Larry Levitt, a senior executive at Kaiser.
Companies say they are responding to the realities of the labor market, but they also say the online marketplaces where individuals can more easily buy plans, a creation of the health care law, have not been an enticing alternative for workers.
Employers may feel differently if the economy turns down and the labor market is less robust or if there is a sudden spike in health care costs. Because workers can no longer be denied an insurance policy because of poor health, companies may be willing to drop coverage under the right circumstances, knowing that insurance is more available to everyone.Photo
Lowe’s offers health insurance plans with deductibles as low as $1,000. CreditMisha Friedman for The New York Times
But there are no plans for a mass exodus.
“The demise of employer-based coverage was definitely overstated,” said Michael Thompson, the chief executive of the National Business Coalition on Health, which represents employers and other buyers of insurance.
The steepest declines in coverage have been in small businesses, which had been steadily dropping coverage before the law. The percentage of small employers offering health benefits decreased from 68 percent in 2010 to 56 percent in 2015, according to the annual Kaiser Family Foundation survey.
But those companies now seem less likely to exit than just a few years ago. In 2013, as many as a fifth of employers with fewer than 500 workers said they were likely to drop coverage in the next five years, compared with 7 percent today, according to a survey from Mercer, the benefits consultant.
Tracy Watts, a senior partner at Mercer, said the stabilization at small businesses was mostly a product of their health care costs staying the same or rising only modestly.
“That will keep you in the game,” Ms. Watts said.
The early tumult in the insurance marketplaces, including the troubled introduction of HealthCare.gov, the federally run insurance marketplace for the Affordable Care Act, also made dropping coverage less tenable, analysts said.
The law has resulted in more coverage for low-income people, as expected. But the unexpected exit by some of the start-up insurers has limited options on the marketplaces. And the plans on the exchanges remain less generous than those offered by many employers, with significantly higher deductibles and a significantly narrower choice of hospitals and networks.
Lowe’s, by comparison, said it has tried to keep employee costs low by contributing about 70 percent of the cost of the annual premiums. It offers plans with deductibles as low as $1,000, versus several thousand dollars for many of the exchange plans.
“The exchanges have been less of a disrupter than I expected,” said Thomas Buchmueller, a business professor at the University of Michigan.
Employers say there is less financial advantage to dropping coverage than first thought. The law penalizes large employers, about $2,000 per worker, when they do not offer health insurance. That is far less than the average cost of family coverage, now $12,600 a year, according to the Kaiser Family Foundation.
But those calculations do not figure in the sizable tax break that comes with providing coverage. In addition, if the employers do not provide insurance, they would almost certainly be pressured — especially in a strong labor market — to add enough money to workers’ paychecks to cover the cost of buying insurance on the marketplace.
Some employers, particularly the smallest businesses and those who employ low-income workers eligible for a subsidy, clearly favor moving employees to the exchanges. Other employers do not.
“The math really worked in favor of providing coverage,” Mr. Thompson said.
While the C.B.O. predicts the employer market will be stable until 2026, 10 years is a long time and federal officials could be wrong .
“They are taking their best guess, and I think it is a reasonable best guess,” said Loren Adler, a health policy analyst at the Brookings Institution in Washington. “I wouldn’t take it as gospel.”
If the cost of providing coverage spikes, as it did through much of the late 1990s and early 2000s, employers might start talking about dropping coverage again, Mr. Adler said. Congress could also take steps to diminish the tax preference for employer-provided insurance.
But so far, employers like Mr. Ihrie of Lowe’s say they do not feel compelled to change.
“People have concluded,” he said, “that it’s better to stay where we are.”
A version of this article appears in print on April 5, 2016, on page A1 of the New York edition with the headline: Health Law Has Enticed Few Companies to Drop Insurance. Order Reprints| Today's Paper|Subscribe
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