At this point, there’s only so much the Obama administration can do to boost health plan enrollment. The proverbial low-hanging fruit has already been picked, as the millions of remaining Americans who lack insurance remain stubbornly committed to living without coverage.
At the end of the last open enrollment period, enrollment in the marketplace stood at 12.7 million.
A new analysis of enrollment in the Patient Protection and Affordable Act (PPACA) marketplace by the Kaiser Family Foundation attributes the plateauing enrollment to a number of factors, most of which are purely economic.
For starters, contrary to expectations put forward by the Congressional Budget Office (CBO), few employers have stopped offering workers health insurance as a result of the PPACA.
The CBO projected that roughly 1 million employees would lose employer-sponsored coverage in 2015 because of the PPACA, and that that number would climb to a whopping 6 million in 2016. But so far, there is no evidence of such a trend materializing.
Kaiser suggests that the incentives for employers to offer insurance to workers may be more powerful than any disincentives that some companies have bemoaned, including the controversial contraceptive mandate and rules that require insurance coverage to meet a number of standards.
Another thing preventing marketplace enrollment from skyrocketing is the fact that many are continuing to buy individual plans directly through insurers, rather than through the PPACA exchanges. Many self-employed people with higher incomes don’t qualify for marketplace subsidies, so they have little incentive to use the marketplace (besides convenience).
But finally, the major obstacle to marketplace enrollment, as well as the over-arching goal of universal coverage, is the cost of insurance. Even with subsidies, many feel the plans they get through the marketplace are not affordable. For many consumers of modest means, the distinction between having no insurance and having a plan with a deductible that greatly exceeds your own savings is largely academic.
Indeed, a recent Kaiser poll found that nearly half of the uninsured cited cost as the reason they forgo coverage.