ACA Exchanges Debut Oct. 1 Amid Uncertainty

September 24, 2013

In This Article

Wild Cards in Enrollment Estimates

The exchanges, along with expanded Medicaid programs in 26 states, will cater to the nation's 48 million uninsured. However, an unknown number of individuals with employer-sponsored coverage are expected to buy replacement policies on the exchanges, which also clouds enrollment forecasts.

For many workers, the switch will be less than voluntary. Home Depot and Trader Joe's recently announced that they are ending medical coverage for part-time employees and directing them to the exchanges. Coverage for part-timers tends to be bare bones, so the comprehensive insurance policies on the exchanges would represent a step-up, albeit a more expensive one.

There's another unknown for the exchange roll-out — will the online process for buying an insurance policy be ready for prime time on October 1, or will it be glitchy, turning shoppers away? As the Wall Street Journal reported last week the exchange software used in most states continues to miscalculate how much an individual would pay for a subsidized policy.

With wild-cards and complications galore, it's little wonder that projections about exchange-coverage enrollment are all over the map.

  • In July, the Congressional Budget Office (CBO) estimated that 7 million individuals would obtain coverage through the exchanges in 2014, 1 million less than its forecast in March 2010. The 7-million figure includes Americans who were previously insured through their jobs. The CBO expects this number to grow to 24 million by 2023. The agency expects another 9 million to enroll in Medicaid and the Children's Health Insurance Program in 2014 — 13 million by 2023 — as a result of expanded eligibility in 26 states.

  • Investors surveyed by Citigroup predict that roughly 4 million Americans will enroll in ACA exchange plans in 2014, the company reported earlier last week.

  • In their annual forecast of healthcare spending released on September 18, economists at the Centers for Medicare & Medicaid Services (CMS) put the number of uninsured Americans obtaining private-insurance coverage in 2014 at roughly 2.9 million, most of them through the exchanges.

USA Today reported in August that in a 50-state survey, 19 states provided estimates of how many of their citizens would use the exchanges, and the grand total came to at least 8.5 million, with 5.3 million alone in California. A study released in June by researchers at the University of California–Berkeley and the University of California–Los Angeles arrived at a more conservative figure of 3.2 million for the state.


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