A Marketplace Odyssey: Countdown to October 1 (84 Days)

This is the first post in a new ACHP blog series that will track health policy updates in anticipation of the start of open enrollment on Oct. 1.

84 days until open enrollment:

Last week the Department of Health and Human Services (HHS) announced the launch of its new Healthcare.gov website and a 24-hour toll-free call service. HHS hopes Americans will log on to prepare for their options in the new online health insurance marketplaces – and that they will come back in October to create accounts, apply for subsidies and compare insurance plans. The site marks the start of outreach season. HHS intends to enroll 7 million Americans through the new marketplaces by March.

As of April, nearly half of Americans were unaware the Affordable Care Act (ACA) was still the law of the land, including a large portion of uninsured. Despite postponing the employer mandate by another year, HHS head Kathleen Sebelius does not appear to be sparing any zeal. With 84 days to go until open enrollment, debates persist over who the 7 million will be.

We have summarized some of the speculation about who will sign up for health care under ACA:

Medicaid beneficiaries: Despite the Supreme Court ruling allowing states to opt out of the Medicaid expansion program, it looks like many will be participating, with the notable exception of several states with large low-income populations, including Florida, Pennsylvania and Texas. In some states, a significant number of currently uninsured Americans will become Medicaid-eligible. A Health Affairs study examines the potentially significant impact on budget and implementation.

Young people: The general assumption – the one President Obama has made explicit – is that the success of the ACA hinges on the participation of young adults. The lower rates Obama has promised for older people and/or those with multiple health care needs depend on healthy consumers in the insurance risk pool. Experts are torn over how Americans between 18 and 26 will act. A number of reports like this one characterize the group as a hard sell. Still, a recent Kaiser Family Foundation poll shows young people value health care.

Same-sex married couples: Last week’s Supreme Court decision to overturn the Defense of Marriage Act (DOMA) changes insurance opportunities for Americans in same-sex marriages. Until the decision, DOMA barred the federal government from recognizing same-sex marriages. Married gays and lesbians, previously considered individuals, will begin recalculating their eligibility for federal subsidies under the ACA.

-Sophie Schwadron
ACHP Intern