The lasting image of the initial health exchange roll out is that of persistent technical problems that plagued the federal government’s insurance exchange website Healthcare.gov. At the start of the 2014 open enrollment period in October 2013, the online marketplace for federally-facilitated insurance exchanges was overwhelmed with a volume of potential customers the website was not designed to handle. A handful of state-based exchanges (e.g., Maryland, Massachusetts and Nevada) also witnessed technical glitches that hampered the enrollment process for countless applicants. It took months to fully correct these technical issues, but at the end of the open enrollment period, an estimated 7.3 million people had enrolled in an exchange nationwide. This final tally, released by Politico, is comprised of the 8 million people who signed up in the regular enrollment period less those who did not pay their premiums in time or dropped out of the exchanges for some reason. An additional 6.7 million people also enrolled in Medicaid during the open enrollment period.
The Obama administration has taken several steps to ensure that Healthcare.gov is fully operational and can handle the traffic of new and returning enrollees during the 2015 open enrollment period, which begins on November 15. These preparations include developing a more streamlined website and more rigorous testing of the site’s server capacity. Additionally, some states operating their own exchanges experienced technical issues during the 2014 enrollment period (such as Oregon and Nevada) have now opted to use Healthcare.gov as their state’s insurance marketplace.
The differences in this year’s open enrollment period will extend beyond the insurance exchanges. Within the last few months, several states have decided to expand their Medicaid programs, most recently Pennsylvania. Utah and Indiana – have been negotiating with the federal government about using federal Medicaid expansion funds to purchase private health insurance for eligible individuals – may decide to expand their state programs in the coming year. Elsewhere, the results of gubernatorial races in the November 2014 elections make expansion in such states as Maine, Wisconsin, and Florida increasingly unlikely. Further, the questions remain whether Arkansas governor-elect Asa Hutchinson will seek to continue or have the political support to extend the Medicaid expansion in the coming years. Finally, in Alaska, the gubernatorial election is still too close to call as absentee ballots are being counted. Independent challenger Bill Walker, who holds a narrow lead at the time of writing, has voiced support to expand the state’s Medicaid program.
In 2015 there will also be an increased penalty to those who haven’t signed up for a plan that meets the minimum essential coverage standards. The tax penalty for not having coverage is the higher of the following:
- $325 per person for the year ($182.50 per child under 18, the maximum penalty per family using this method is $975); or
- 2% of the individual’s annual household income.
These penalties will be assessed when individuals without coverage file their federal income tax return in early 2016.
The big question remaining for the 2015 open enrollment period is how many people will sign up for insurance during this period. Health and Human Services Secretary Sylvia Matthews Burwell stated the administration does not have a goal at this point, but the Congressional Budget Office estimated that 13 million people (new and returning enrollees) will sign up for insurance through the exchanges in 2015. It may be unfair to expect such gains this year given that this enrollment period is 3 months long (2 shorter than last year) and those individuals most motivated to purchase insurance would have already signed up in 2014. Separately, CMS has taken steps to ensure that people are not required to actively re-purchase insurance; individuals who “do nothing” will remain enrolled in their current plans with the same premium tax credit and other financial assistance.