Burwell, HHS, Obamacare
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The Obama administration is making a push to strengthen ObamaCare and make it more sustainable before leaving office. 

The enrollment period for 2017, which begins Nov. 1, comes at a challenging time for the healthcare law. Insurers have been dropping out of its marketplaces and hiking premiums due to financial losses from ObamaCare plans.

{mosads}Reversing that trend will require more people and healthier people to sign up.

The administration projected Wednesday that about 1 million more people would sign up for ObamaCare insurance plans for 2017, bringing total enrollment to 13.8 million. The goal is modest, but meeting it could help ease concerns in the insurance industry. 

“The biggest opportunity we have to strengthen the Marketplace with a bigger, healthier risk pool is right in front of us — this upcoming open enrollment,” Health and Human Services (HHS) Secretary Sylvia Mathews Burwell said Wednesday. “This is the last open enrollment for this administration. We’re going to make it count.”

The mere projection of an increase in enrollment has calmed nerves in the healthcare world. Some had speculated that ObamaCare enrollment could even decline next year due to premium hikes or insurers leaving the system.

“I’m encouraged that it does show continued growth,” said Joel Ario, a former HHS official under President Obama now at Manatt, Phelps & Phillips. “Some people had been predicting that the marketplaces are going to lose membership, rather than gain, so this is certainly a step in the right direction.” 

But the administration will face headwinds in reaching its goal. 

Premium increases are averaging about 25 percent for next year, according to ObamaCare analyst Charles Gaba. Middle-class people, who receive less financial help under the law than those with lower incomes, had already been enrolling at lower rates because of concerns about affordability.

“The biggest risk is that people who don’t have the protection [of] subsidies will see big premium increases and could reconsider,” said Larry Levitt, an expert on the law at the Kaiser Family Foundation.  

He said the administration’s enrollment target is “ambitious.” 

The administration emphasizes that 85 percent of ObamaCare enrollees are cushioned against premium hikes by financial assistance. But the other 15 percent, as well as about 7 million people who buy individual coverage outside of the law’s marketplaces, do not have that protection. 

But even if enrollment held steady at around 10.4 million people, many experts say the law would not be in jeopardy. 

“I think it’s reached critical mass,” Ario said. “The program is going to stay in place.”

But without more enrollment growth, he added, “it will be more difficult, it will require more stabilization measures.”

He pointed to improvements that could be made to programs that shift money among insurers to cushion against heavy losses, such as “risk adjustment” and “reinsurance.” Republicans have decried those programs as “bailouts” of insurers.  

Burwell told reporters Wednesday that even with current enrollment numbers, “the market is sustainable.” 

But she added that growth would help. “Certainly if one can add to the risk pool and change the risk pool, that’s something we want to do,” she said. Enrollment growth is just “one element of many” being used to stabilize the situation for insurers, she said. 

ObamaCare enrollment is far below initial Congressional Budget Office projections, which had forecast more than 20 million enrollees by this time. But some insurers have been able to adapt to a smaller and sicker market, using tactics like narrowing the number of doctors available to control costs and improving communication with consumers about their care.

The administration emphasizes that 20 million people have gained coverage from the law — including the marketplaces and Medicaid expansion — and the uninsured rate is at an all-time low.  

Still, the administration is trying to boost the number of young people signing up next year, partly through wider outreach. The number of young people enrolled has stayed flat in the last two years, and the administration is looking to change that.  

Tactics include a partnership with Twitch, a social platform for gamers, to raise awareness about coverage options, as well as a new emphasis on the financial penalty for lacking insurance. 

The administration has acknowledged that improvements are needed to the law, calling for a public option to increase competition among insurers and increased financial assistance to make coverage more affordable. Democratic presidential nominee Hillary Clinton has made similar proposals, but they face stiff resistance from Republicans.  

“We are hopeful that soon, we’ll see bipartisan collaboration in Congress and the States that will help us make improvements to the law,” Burwell said. 

Burwell pointed to some steps the administration has already taken this year to stabilize the marketplaces. For example, HHS has tightened up the rules somewhat for extra signup periods, known as special enrollment periods (SEPs), that insurers say sick people are using to game the system. 

Michael Adelberg, a former HHS official under Obama now at FaegreBD, said if the administration “is successful in bringing in a million new younger and healthier enrollees during open enrollment, and curbs expensive SEP enrollment afterward, then 2017 will be the year that the exchange market starts to stabilize.”  

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