Obamacare sign-ups for 2017 projected at 13.8 million, slight rise over 2016

A woman reads a leafleft on Obamacare at a health insurance enrollment event
Lucy Nicholson | Reuters
A woman reads a leafleft on Obamacare at a health insurance enrollment event

The nation's top health official said Wednesday she expects nearly 13.8 million people to sign up for Obamacare insurance plans for health coverage in 2017 during the upcoming open enrollment season.

That estimate represents a modest increase in the number of people — 12.7 million — who signed up for Obamacare plans during open enrollment for 2016.

The 9 percent projected rise would roughly equal the bump seen in sign-ups for this year, when enrollment growth in Affordable Care Act plans began leveling off.

"We're confident that millions of Americans will choose to enroll when they learn that quality, affordable health insurance is within reach," said Health and Human Services Department Secretary Sylvia Burwell.

"We believe 13.8 million sign-ups during the upcoming open enrollment will help keep driving down the national uninsured rate, which is already the lowest in our nation's history," Burwell said.

Her projections come less than two weeks before the start of open enrollment, which will run from Nov. 1 through Jan. 31.

HHS also said that over the course of 2017, it estimates that an average of 11.4 million people will have so-called effectuated enrollment. For enrollment to be official, or effectuated, a person must pay their premium for the first month of coverage from their health plan.

For the first half of 2016, effectuated enrollment was 10.5 million people, officials said Wednesday.

It is normal in the insurance industry to see a drop between the total number of people who sign up for a plan, and the number of people who are enrolled. Some customers fail to pay their first premium, and others drop their plan during the year because they get coverage elsewhere, or for other reasons.

The estimates released Wednesday are for people who will be covered under plans sold on HealthCare.gov, the Obamacare exchange that serves 38 states, and the marketplaces run by individual states. It does not include people covered by individual plans — as distinct from insurance through an employer — sold outside of the government-run exchanges.

The estimates come as many states have approved sharply higher premium rates for 2017 plans sold on Obamacare exchanges, and several large insurers have significantly decreased the number of states where they sell such plans.

Most people who qualify to buy coverage on Obamacare exchanges also have low or moderate incomes that make them eligible for tax credits, or subsidies, that can significantly lower their premiums.

Those subsides, which almost 85 percent of enrollees get, can largely, or completely insulate them from the effects of premium rate increases. About 56 percent of Obamacare customers also have incomes low enough to qualify them for financial aid that reduces their out-of-pocket health costs.

However, people with higher incomes, or people who buy individual plans outside of the exchanges, are not eligible for subsidies, and bear the full effect of premium hikes.

"We know from three years of experience that the [Obamacare] marketplace offers a product people want and need," Burwell said in a speech Wednesday morning.

"I know that there has been much talk and discussion about marketplace rate increases this year. But headline rate changes don't actually reflect what the vast majority of consumers will pay."

"Thanks to financial assistance, most people shopping on the marketplace will still be able to find a plan for less than $75 per month," she said. "Marketplace consumers will continue to have affordable options available."

The Obama administration has made it a priority this coming enrollment season to get the remaining uninsured people signed up into coverage, particularly younger adults who lack insurance.

One of the reasons that premium rates are rising so much this year is that the plans have not signed up enough young, healthy adults whose premium payments would offset the cost of providing benefits to older and sicker enrollees.

There are 10.7 million Americans who remain uninsured, but are eligible for coverage through an Obamacare plan. About 40 percent of those uninsured are adults between 18- and 34-years-old, and 85 percent of all the eligible uninsured are eligible for subsidies to buy Obamacare.

There are a number of reasons that people without insurance continue to resist signing up for coverage, even in the face of the Obamacare mandate that imposes a fine of those who lack health coverage during the year.

Those reasons include an inability, or perceived inability, to pay for insurance. Many of the uninsured are unaware that subsidies are available to them.

HHS said Wednesday it expects that 3.5 million currently uninsured people will sign up for Obamacare plans during the coming open enrollment.

The remaining estimated sign-ups will come from 9.2 million people projected to re-enroll in an Obamacare plan, and 1.1 million people who currently have off-marketplace non-group coverage, officials said.