On Jan. 1, health insurance goes into effect for everyone who purchased a policy through the new insurance exchanges by Dec. 24.
The exchanges, a core component of the Affordable Care Act, got off to a rocky start with technical glitches hampering the main website. Although the most obvious problems have been fixed, there continue to be reports about the potential for trouble on the back end, with peoples enrollment information not getting transmitted to insurers properly.
If nothing else, the exchanges seem to be gaining traction with consumers. Marilyn Tavenner, RN, BSN, MHA, administrator of the Centers for Medicare & Medicaid Services, stated that more than 975,000 people enrolled on the federal insurance exchange during December.
That would push enrollment for Jan. 1 coverage past 1.1 million on the federal insurance exchange. Dan Mendelson, CEO of Avalere Health, a market analysis firm, told the Associated Press that total enrollment likely is around 2 million when factoring in numbers from the 14 states running their own exchanges.
That total is short of the 3.3 million the Obama administration reportedly projected would be enrolled by Jan. 1. The projected total by the March 31 end of the open enrollment period for 2014 is 7 million.
The administration has not released information on the demographics of the newly insured. Insurers are hoping for a high number of younger and healthier enrollees to offset projected costs of treating those who are older and sicker. If the 2014 breakdown does not meet insurers expectations, premiums could rise in subsequent years of the ACA and insurers could leave the exchanges.
We are in the middle of a sustained, six-month open enrollment period [in which] we expect to see enrollment ramp up over time, much like other historic implementation efforts weve seen in Massachusetts and Medicare Part D, Tavenner wrote in a Dec. 29 blog post.
Although the ACA became law in March 2010, key components were put off until 2014. The two most highly publicized elements taking effect Jan. 1 are the exchanges and the mandate for most Americans to buy health insurance or owe a penalty.
In addition, new rules prevent insurers from denying coverage or charging higher premiums to people with pre-existing conditions; and eliminate yearly limits on what insurers can spend on coverage (lifetime limits were eliminated in 2010).
Also, expanded Medicaid eligibility will begin in the 25 states (and Washington, D.C.) that chose to expand the program with federal funding. The other states will cover significantly less than the percentage of uninsured that was envisioned under the law. In addition to the approximately 2 million people enrolled in private insurance plans, 3.9 million already have been declared eligible for Medicaid under the ACA.
The employer mandate, which requires all businesses to offer coverage if they have more than 50 employees, was delayed until 2015.