Health and Science

Ho, ho, hum: Holiday horror for Obamacare sign-ups


The holiday season is a great time for getting gifts, but an awful time to enroll people in Obamacare, a new analysis finds.

However, enrollment could be boosted if Obamacare's sign-up period was moved forward to months leading up to the tax-filing deadline in mid-April, when people are feeling more flush from refunds and the expectations of them, argued the authors of the article in the journal Health Affairs.

Their report notes that Obamacare's next open enrollment period begins at a time—mid-November—when lower-income people in particular are financially and mentally "stressed by demands of the holiday season," and when they are dramatically less likely to be searching for information about health insurance on the Internet.

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Those factors, in turn, could dampen overall enrollment in Affordable Care Act exchange-sold plans for such coverage during the Nov. 15, 2014, to Feb. 15, 2015, enrollment window, argued the authors. They also could negatively affect people's ability to select the right health plan, a complicated task for anyone, the paper said.

But the government says nothing is going to change. "Our enrollment period is set," said Aaron Albright, a spokesman for the Centers for Medicare and Medicaid Services, which administers Obamacare.

The Health Affairs authors focused on the effects on lower-income people in their paper because that group tends to make up the bulk of Obamacare enrollees.

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"The seasonality of financial and mental stress has serious implications for the ACA's goals of maximizing enrollment in marketplace health plans and maintaining a healthy mix of enrollees with low and high risks of having high medical expenses," wrote authors Katherine Swartz and John Graves.

"Given what is known about how financial stress affects people's bandwidth for making decisions, holding open enrollment just before or during the holiday season is a mistake."

And that effect could become more pronounced after this year, when Obamacare's open enrollment periods are scheduled to run only over two months, from Oct.15 to Dec.15.

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The authors suggested moving those enrollment periods to between Feb. 15 and April 15 of each year, when "many lower income people receive their income tax refunds and [earned-income tax credit] payments then, so they are more likely to have the mental bandwidth about their health insurance options and to enroll in a plan."

Obamacare's first open enrollment period, for the 2014 plan year, lasted a bit longer than six months, from Oct. 1, 2013, through mid-April, in most states. Eight million people selected individual health plans via government-run insurance exchanges during that time.

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But with the exception of next year, subsequent open enrollment periods will closely mirror similar insurance sign-up windows for group insurance plans offered to workers by their employers, that is, right before the winter holiday season and the end of the year.

The authors for their research used the Google Trends tool to pull weekly data on search "queries related to financial security and health insurance." The authors focused on search terms that included "cash advance," "payday loan," or "payday advance," as well as searches about savings accounts and tax refunds.

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The data showed that "seasonal trends in financial insecurity were more pronounced in the summer months and just before the holiday season," they wrote. On the other hand, there was a jump in search terms suggesting that people felt more financially secure in the period from January to April.

"Internet searches for information on health insurance also displayed significant seasonality, with query volume dropping substantially during the holiday season," the authors noted.

"Search volume then spiked considerably just after the holiday and leaving into the new year. This evidence is consistent with the notion that people may lack the mental bandwidth to make complex decisions during the holiday season but that once it ends, they begin to think more comprehensively about their plans for next year."

George Brandes, director of tax preparer Jackson Hewitt's health-care programs said, "We have always been convinced that tax filing is the key to helping folks buy health coverage under the ACA."

"This new evidence shows that not only would tax time enable more people to sign up, it's also a time of lower financial stress, so people can make better decisions about the coverage to buy," Brandes said.

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—By CNBC's Dan Mangan.