CBO Issues Updated ACA Projections: Drops Private/Public from 7M/9M to 6M/8M

Hat Tip To: 
Dan Diamond

An interesting, but hardly surprising development today: The CBO, which had previously projected that appx. 7 million people would enroll in Private QHPs via the Health Exchanges created by the Affordable Care Act (as well as 9 million additional people enrolling in Medicaid or CHIP thanks to the expansion provisions within the ACA) by the end of 2014 have now reduced both of these projections by 1 million apiece, to 6 million and 8 million in the first year. Thanks to Dan Diamond for bringing this report to my attention.

You have to scroll all the way down to page 108 of the report to find it, but here's the relevant screen shot, and the relevant paragraph from pages 112 - 114 of the report:

Lower Enrollment in the Exchanges, Medicaid, and CHIP
In light of technical problems that impeded many people’s enrollment in exchanges in the first months of the open enrollment period, CBO and JCT have reduced their estimate of enrollment for the current year from 7 million to 6 million people. Between October and late December 2013, about 2 million people selected a health insurance plan through an exchange.11 That figure is significantly below the total that CBO and JCT estimate will enroll in 2014. However, the open enrollment period lasts through March, and CBO and JCT anticipate that, similar to initial enrollment patterns for other new health care programs, the number of people who sign up will increase sharply toward the end of the period. In particular, people who choose to enroll primarily to avoid a penalty for being uninsured may wait until the end of the open enrollment period to choose a plan. Thus, it is possible that the number of enrollees will reach the 7 million originally projected for 2014, just as it is possible that the number will fall short of the current estimate of 6 million. In any event, CBO and JCT estimate that enrollment in exchanges will rise sharply in the next few years—reaching 22 million by 2016—as people become more familiar with the new insurance options and subsidies. 

In other words, the mess with the HC.gov website (as well as some of the state-run exchanges, some of which, such as Oregon, Hawaii and Massachusetts are still having serious problems) back in October and early November effectively killed the first 20% of the 6-month enrollment period, so they're knocking their projections down a peg or two. Interestingly, even though they're dropping 2 million off of these figures, they only project the reduction in uninsured to go down by 1 million, which I assume is due to a mish-mash of rounding numbers, demographic changes and the like.

So, how does this impact The Graph or The Spreadsheet on this website?

Frankly, I'm inclined not to really change anything, other than to include a prominent note about this change. Politically, no one is going to care that the CBO dropped their projections, especially when they did so over 2/3 of the way through the enrollment period. The bottom line is, if Private QHP enrollments reach between 6-7 million, it'll be spun as an unqualified success. If it hits between 5-6 million, it'll be considered a "qualified" success (ie, "considering the technical problems in October" will be included with every reference). If it comes in below 5 million by March 31st, it'll be spun as a disappointment or a disaster...which, of course, ACA opponents will call it no matter what.

Of course, as the CBO report notes, it's also possible that they'll hit 7M after all. More importantly, what really matters won't be whether 5, 6 or 7 million enroll this year, but how it plays out over the next several years...as the CBO also notes. Personally, I had already noted (on Twitter a few days ago) that I expect them to hit somewhere around 6 - 6.5 million, which isn't particularly profound either.

In the words of Jeb Bartlett...what's next?

Oh, one other interesting tidbit: You know how the freakout over the "OMG! 5MM Policies Cancelled!!" led President Obama to allow a 1-year extension (at the individual states' discretion) of non-ACA-compliant policies? Apparently the CBO has some numbers on that as well:

Random note: CBO expects about 1.5 million people to renew non-Obamacare-compliant policies under WH's administrative fix.

— Dylan Scott (@dylanlscott) February 4, 2014