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Open Enrollment Target Call

Sylvia Mathews Burwell
October 15, 2015
Washington, DC

We still have work to do to bring access to affordable, quality health insurance to all Americans. But we’re getting closer to that goal. By working smarter in this Open Enrollment, we can ensure the next generation of Americans has a health care system that works better for everyone.


Good morning.

In just 16 days, the Health Insurance Marketplaces open for the third Open Enrollment. This is an important time to help more Americans access quality, affordable health care. Today, I’d like to talk to you about the opportunities and challenges before us, and share our effectuated enrollment goal for 2016.

As most of you know, as the ACA’s coverage provisions have taken effect, 17.6 million uninsured Americans have been able to get covered. That’s the largest decrease in the uninsured in decades.

Let me now turn to this year. Based on our most recent analysis for this Open Enrollment, about 10.5 million uninsured Americans are currently eligible for Marketplace coverage. So we are starting this year with significantly fewer uninsured than last year and a population that is harder to reach. 

Here is what those 10.5 million eligible uninsured look like:

Almost half of those who could qualify for Marketplace plans are what we might call the “young invincibles,” between the ages of 18 and 34.

Almost 40 percent of the uninsured who could qualify for Marketplace plans are living between 139 and 250 percent of the poverty level—which is about 30 to 60 thousand dollars for a family of four. Almost 8 in 10 have an income that qualifies them for financial assistance.

More than a third are people of color: About 19 percent are Hispanic, 14 percent are African-American, and 2 percent are Asian. There are also more men than women; around 57 percent are male.

And we know that the remaining uninsured have a lot of concerns about whether they can afford coverage. Nearly 8 in 10 people without insurance have less than $1000 in savings, and about half have less than $100 in savings. Almost 60 percent are either confused about how the premium tax credits work or don’t know that they are available.

You are also aware that we expect our effectuated enrollment number for the Marketplace to be about 9.1 million at the end of 2015.  Using that as a starting point, our analysts have come up with a range for how many individuals will sign up for Marketplace coverage by the end of Open Enrollment. They then looked at how many of those are likely to have effectuated coverage at the end of 2016.

For the first element—re-enrollment by current enrollees—we looked primarily at the re-enrollment rates of last year’s Open Enrollment. From that analysis, we came to the range of 7.3 to 8.8 million plan selections.

We also expect 900,000 to 1.5 million sign-ups to come from those who have coverage on the individual market outside the Marketplace and want to shift to Marketplace coverage. 

Finally, there are those who will come from the 10.5 million eligible uninsured. We expect to draw in about 2.8 million to 3.9 million of those individuals.

Combining these projections, we have estimated a range of 11 million to 14.1 million for total Marketplace plan selections in 2016.

We then looked at likely effectuated enrollment at the end of 2016.  We expect to see customers come and go as their life circumstances change— for example, they will drop Marketplace coverage when they become eligible for employer plans, and they will sign up after Open Enrollment closes if they get married or move out of state.

As has been true in the first two years, we expect those who sign up through special enrollment periods will not offset the number of people who leave, some for other forms of coverage. Others we will also lose over non-payment or data-matching issues. As a result, our effectuated number at the end of 2016 will be lower than the initial number of plan selections. 

We estimate a final range of 9.4 million to 11.4 million effectuated at the end of 2016.

That’s a big range because there is a high degree of uncertainty about any forecast, and we have only two previous Open Enrollments to base our projections on.

Here, I want to make one important and related point, which has bearing on our expectations for this year’s enrollment. Early projections for Marketplace sign-ups envisioned a significant migration from employer-sponsored coverage. That shift has not occurred.

With that said, I have the responsibility to manage this program on a day-to-day basis, and I don’t have the luxury of a range. I believe in clear metrics and goals, so like last year, I have picked a point that we will manage for, and that point is 10 million people with effectuated enrollment at the end of 2016. That’s nearly 1 million more than this year.

We believe 10 million is a strong and realistic goal. We’ve seen high levels of satisfaction with the Marketplace and expect the vast majority of our current customers will reenroll. And our target assumes that more than one out of every four of the eligible uninsured will select plans.

But while our audiences may be harder to reach, we’re working smarter to reach them. The remaining uninsured population is younger, more likely to be male, and tend not to know enough about the Marketplace and the financial help that’s available.

So we’re targeting our outreach and our messaging to make sure we get people the information they need to make the right decision for their families. For instance, we’re going to be talking a lot about financial assistance, since we know costs are on our customers’ minds. 

Starting November 1, our targeted outreach campaign will reach Americans where they live, work and play to inform them of the opportunity to enroll or re-enroll in coverage.

As we prepare for the start of Open Enrollment, we are working with a wide array of partners to get the word out—from nonprofit organizations and health care providers to businesses and government agencies. Many of these partners will play a critical role in our ground game—directly reaching consumers with information in their neighborhoods.

In-person assistance from Navigators and assisters has proven to be an incredibly important avenue for consumers to get the right coverage. I'm pleased that Navigators and assisters will be available in even more geographic areas this year.

And we are always working hard to improve the consumer experience, with upgrades to our site and more tools to help people find what they are looking for. We want to make it as easy and simple as possible to find the right plan at the right price.

This Open Enrollment is going to be a challenge, but ultimately, having fewer uninsured Americans to sign up is a good problem to have. We’re also doing the work now to make sure that when bumps arise, as will happen, we’re ready for them. 

We still have work to do to bring access to affordable, quality health insurance to all Americans. But we’re getting closer to that goal. By working smarter in this Open Enrollment, we can ensure the next generation of Americans has a health care system that works better for everyone.

Content created by Speechwriting and Editorial Division 
Content last reviewed on October 15, 2015