The administration on Monday said fewer than 10 million Americans will enroll in Obamacare’s health exchanges this go-around, well short of the 13 million target congressional scorekeepers deemed critical to its economics, suggesting another rocky rollout in the law’s second year of full operation.
Policy advisers at the Health & Human Services Department estimated that 9 million to 9.9 million people would enroll through the exchanges — or only a slight increase over the 8 million that the administration says were active at the end of the first enrollment period this April. The Congressional Budget Office, which is the government’s official scorekeeper, had predicted the law would need 13 million customers on the exchanges.
Republicans, who are plotting ways to use their new control of both chambers of Congress next year to roll back or repeal the Affordable Care Act entirely, said the lower estimates are another sign of the law’s problems.
“Under the president’s health care law, Americans have experienced broken exchanges, canceled coverage, higher premiums and unaffordable deductibles,” said Rep. Darrell E. Issa, California Republican and chairman of the House oversight committee, which investigated last year’s botched rollout. “Despite the administration’s habit of moving the goal posts, the fact is Obamacare is simply not delivering the results Americans were originally promised by the president.”
The number of enrollees is key, because if too few take part in the exchanges, the pool of customers is too small, and it could skew the economics of Obamacare, forcing insurers to raise premiums and pushing even more people to forgo coverage, choosing to pay the tax penalty instead.
The second round of enrollment begins Saturday and ends Feb. 15. The administration has been reluctant to set a goal for itself this time.
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In the first enrollment, which lasted from Oct. 1, 2013, through April of this year, the administration initially appeared poised to fall well short of the CBO’s 7 million customer estimate. But after several deadline delays and feverish work to fix botched federal and state websites, the government said it enrolled 8 million and, of those, 7.1 million have paid their premiums and retained coverage.
HHS projects 5.9 million, or 83 percent, of initial customers will re-enroll.
The exchanges allow qualified Americans to compare and shop for private health plans in their state through a website or by phone, often with the help of income-based government subsidies. It is a key pillar of the 2010 health care law, alongside the expansion of Medicaid in states that opt to allow young adults to stay on their parents’ plans until age 26.
The overhaul is relatively new, groundbreaking in its ambition and surrounded by constant controversy, according to Gary Claxton, vice president at the Henry J. Kaiser Family Foundation, a nonpartisan health policy organization.
“I’m not sure any particular set of numbers is right or not right,” he said.
But Obamacare critics saw the revised benchmark as a clear attempt to exceed expectations once again.
“After years of broken promises and a painfully flawed launch, the administration is again trying to rewrite its definition of success for the president’s signature law on the eve of Saturday’s second enrollment,” said Rep. Marsha Blackburn, Tennessee Republican and vice chairwoman of the House Energy and Commerce Committee. “Last year, while cancellation notices were outnumbering new enrollments, the administration completely abandoned enrollment as a measure of success. No matter how you dress it up, bad policy is bad policy.”
To calculate its projection, HHS examined the share of households that could seek insurance on the marketplace. It arrived at the 9 million to 9.9 million range for the coming year by looking at behavioral trends among those who were eligible for financial assistance and those who earned too much to get a subsidy during the first round of sign-ups.
The new projection comes as Republicans prepare to take full control of Congress and redouble their efforts to repeal the law.
While recent polls show many Americans would prefer to fix or improve the law rather than scrap it altogether, more people tend to view it unfavorably than favorably.
Adding to its woes, the Supreme Court decided last week to take up a case that could gut the law by reining in its subsidies, and the overhaul was the target of many negative ads in a bruising election year.
“There aren’t too many products that have more ads telling people they shouldn’t buy it than saying they should,” said Timothy Jost, a law professor at Washington and Lee University and an expert on the health care law.
Mr. Jost said HHS’s analysis also suggested the administration will face headwinds in finding customers who didn’t sign up in the first go-round.
“All of the low-hanging fruit has been picked already,” he said.
In its policy brief, HHS reiterated that the Affordable Care Act’s main goal is to cut the ranks of the uninsured, and that marketplace enrollment is “just one means to that end” alongside Medicaid expansion and exchanges that serve small businesses.
“Thus,” it said, “we will measure our success by whether we are making continued progress in reducing the number of uninsured Americans.”