The Congressional Budget Office thinks a total of 13 million people will be insured through the heath care exchanges under the Affordable Care Act in 2015.
The Department of Health and Human Services says, no, it’ll be in the 9 million range.
One reason for the discrepancy: The CBO assumes lots of employers will shift more workers from company insurance plans, to the exchanges next year. But in reality, they may not be in any rush.
“The technical problems in the first year of the Affordable Care Act may have given employers some pause about putting their workers in these marketplaces,” says Larry Levitt, senior vice president at the Kaiser Family Foundation.
And, it’s going to be a lot harder to sign people up this year. There's only a three-month enrollment period, versus six months last year.
But also, people who were most interested in getting insured signed up last year.
The people left are harder to reach. Some are healthy and don’t think they need insurance.
Or they’re immigrants - worried about deportation.
“Even if the individual is here legally maybe they have family members that aren’t," says Linda Blumberg, a senior fellow in the Urban Institute’s Health Policy Center. "And that creates anxiety about interacting with government programs.”
So, if fewer people sign up for coverage next year, what does that do to premiums? Does it jack them up? Maybe.
That's because if you have more people on the exchanges, you could get a better mix of healthy people. If you have too many people needing lots of care, premiums go up.
“You’re going to be left with people who have higher health needs," says Sabrina Corlette, senior research fellow at the Georgetown University Center on Health Insurance Reform. "They’re going to end up costing more money. And that’s going to come out in the premiums.”
However you crunch the numbers, Corlette says, higher numbers are better.