“The Health Insurance Marketplaces are working. We’ve seen a historic reduction in the uninsured and consumers are finding the coverage they need at a price they can afford.”

- HHS Secretary Sylvia Burwell

It’s hard to disagree with HHS Secretary Burwell that the health insurance exchanges are working. Over 10 million Americans are enrolled in federal and state exchanges and 85% of those are receiving a tax credit subsidy to make their premiums affordable.  

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ACA Enrollment Update: What It Means for Legislation—Part 2

Mon Aug 24, 2015

“The Health Insurance Marketplaces are working. We’ve seen a historic reduction in the uninsured and consumers are finding the coverage they need at a price they can afford.”

- HHS Secretary Sylvia Burwell

It’s hard to disagree with HHS Secretary Burwell that the health insurance exchanges are working. Over 10 million Americans are enrolled in federal and state exchanges and 85% of those are receiving a tax credit subsidy to make their premiums affordable.

On the other hand public opinion polls have consistently shown that a majority of Americans has an unfavorable view of the Affordable Care Act and that most would like to see changes.

Politics aside, the latest enrollment data have at least three big implications for the future of the Affordable Care Act:

  • Secretary Burwell is clearly right that the health insurance marketplaces are working as intended. Millions of previously uninsured or underinsured Americans, many with serious pre-existing medical conditions, have enrolled in federal and state exchanges—with the help of generous premium and cost-sharing subsidies.

    While it remains to be seen whether insurance issuers will continue to offer plans in the exchanges and whether real-world claims experience will push premiums too high, most would give the ACA marketplaces a passing grade.

  • Future amendments to the Affordable Care Act—and there is little doubt the law will be changed, probably in 2017—are not likely to disrupt the basic structure: federal and state-run insurance exchanges and tax credits to make insurance more affordable. After several years the subsidy-based exchange architecture now seems firmly installed.

    Moreover, with states like Wisconsin, North Carolina, Florida and Georgia having over 90% of their exchange enrollees receiving financial aid, senators and representatives, regardless of party affiliation, are unlikely to disqualify their constituents from ACA benefits.

  • Notwithstanding the promising enrollment figures, Democrats and Republicans will heed their constituents: the 2010 Affordable Care Act, like most comprehensive new laws, needs to be fixed. Even strong supporters of the law favor targeted improvements.

    Against this backdrop the health reform law is certain to be a focus of the presidential campaign, with the Individual Mandate, the Employer Mandate and the so-called Cadillac Tax in the spotlight.

Apart from specific ACA provisions, there’s concern about how much the law will cost over time, rising insurance premiums and disruption of existing coverage. And HHS will be urged to strengthen eligibility verification for government subsidies.

What does all this mean for changes to the Affordable Care Act? Regardless of which party wins the White House next year, the recent ACA numbers—both for exchange enrollment and for subsidies—suggest that the new President likely will work with the Congress to mend, but not end, the Affordable Care Act.