Obamacare's second open-enrollment period begins Saturday, posing new challenges for the health care law even after the surprising success of its first year.
Roughly 7 million people are now covered through the law's exchanges, and enrollment is already strong enough to take the worst-case scenarios, like an insurance "death spiral," off the table. But it's not yet strong enough to ensure that Obamacare meets its most fundamental objective: eventually reducing the number of uninsured Americans by about 25 million.
To get there, the second open-enrollment period also has to be a success. But it poses new tests for the administration, in addition to some familiar ones.
Health and Human Services Secretary Sylvia Mathews Burwell has consistently pushed back against the idea that this is "Round Two" for the Affordable Care Act, and she has a point: Although it's the second round of new enrollment, keeping existing customers covered—and keeping them happy—is just as critical to the law's success, and this is the first time HHS is taking on that phase of the enrollment challenge.
Here are the three biggest questions facing the White House and HHS as the second enrollment period gets under way:
1. Will the website work?
No one needs to be reminded what happened last time HealthCare.gov launched. The technological disaster became a political disaster for the White House, which faced months of questions about basic competence as well as—at the time, reasonable—doubts over whether Obamacare could get even close to its enrollment goals. The website eventually worked, though, and HHS officials say they're ready to go this time with an even better, more streamlined site.
They've already previewed some key changes: The online application for new consumers is now just 16 pages, down from 78 last year. The old site used to ping a complicated data hub for every single answer on the application, rather than sending one full page of responses at a time. The old site also freaked out when users hit "back"; the new one, apparently, will be able to handle the "back" button. Officials spent five weeks on end-to-end testing this year, a big change from the rushed or nonexistent tests of the first launch.
All of this may sound like grading on a curve—a website that lets you hit "back" does not make a successful piece of public policy, after all. But the site was a major problem last year, and you can imagine critics' glee if it's seriously flawed again this time. So, a working website is ultimately pretty important. Some problems and downtime are inevitable, but they need to actually be minor "glitches" this time, rather than catastrophic system failures, to be excusable.
2. Will existing customers shop around?
The biggest potential problem for Obamacare's next round is a complicated one. The short version is that if people who already have coverage through Obamacare don't go back through the system and compare their options again, their costs could rise substantially.
It's all a somewhat ironic byproduct of the law's success at promoting more competition among insurers. As new carriers come into new markets, people who automatically renew their plans for a second year could see their tax subsidies fall, on top of any premium increases their insurer is seeking. In some cases, declining subsidies could cause consumers' costs to spike even if their insurers don't raise their premiums at all. And some people won't know their costs went up until they get a bill from the IRS.
If you already have Obamacare, the safest way to ensure that your costs stay the same is to go back through the system and compare your new options. If your income hasn't changed, you can almost certainly protect yourself from cost increases that way. But it's not clear how many people will take the extra step, and how many will simply take advantage of the automatic-renewal option. If the bulk of initial enrollees don't shop around again, the administration could head into tax season facing a group of angry consumers hit with bills they weren't anticipating.
3. How many people will sign up?
Earlier this week, HHS set a new target for enrollment through the law's exchanges. The department expects the new marketplaces to cover between 9 and 10 million people in 2015. That's significantly fewer than the 13 million projected by the Congressional Budget Office, and obviously HHS has every incentive not to set expectations any higher than what it's sure it can achieve.
But there are real and unique challenges facing the enrollment push this year. The first open-enrollment period was surrounded by all sorts of publicity—from celebrities tweeting and cutting TV commercials about enrollment to negative publicity around HealthCare.gov. This year will be different, and much more low-key. The approach this time is focused more on community organizations and specific targeting than on big, splashy, nationwide campaigns.
The administration and its allies also have a somewhat more difficult task: They have to find and enroll the people who didn't sign up last year even with all the hype and hoopla over enrollment. And they have to do it in half the time—the second open-enrollment window is just three months long, compared with the six months set aside for 2014 enrollment.
This article is from the archive of our partner National Journal.
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