WASHINGTON — The government’s insurance website is faster and easier to use, but as a third sign-up season gets underway, President Barack Obama’s health care law is approaching limits.
Enrollment on the federal and state exchanges began Sunday. While the law’s expanded coverage has reduced the uninsured rate to a historic low of about 9 percent, the gains will be harder in 2016.
Supporters may feel they’re running to stay in place, rather than taking a victory lap during the president’s last full year in office.
The reasons have to do with the structure of the complicated law, the effects of a major change introduced by the Supreme Court and political divisions likely to be magnified in an election year.
The fate of the Affordable Care Act — known as “Obamacare” to its detractors — is very much in the hands of the next president. A weak sign-up season could embolden opponents who are so far unwilling to relent.
The law’s two major engines of coverage expansion face challenges simultaneously.
Costs are going up on the private, taxpayer-subsidized coverage sold through and state insurance exchanges, and many of the more than 10 million eligible uninsured Americans are skeptics. They tend to be younger people on tight budgets, with other priorities for spending their money.
A sharp increase in fines may sway at least some fence-sitters. In 2016, the penalty will rise to $695 or 2.5 percent of taxable income, whichever is higher. This year, the fine is the greater of $325 or 2 percent of income.
Reading the signs, the Obama administration has set a modest sign-up target of about 10 million private insurance customers enrolled and paying their premiums by the end of 2016. Most would be consumers renewing from this year, but one-third or more are expected to be new customers previously uninsured.
Part of the challenge for the administration is that the market for individual health insurance policies is volatile. People drop coverage as their circumstances change, for example landing a job that comes with health insurance.
On the law’s Medicaid expansion, the other big mechanism driving coverage, the limitations are clearer and perhaps more consequential.
The 2012 Supreme Court decision that upheld the law’s individual coverage requirement also gave states the choice to decline expanding Medicaid. Across the South, Republican-led states have turned down the Medicaid option, leaving millions uninsured.
Many are trapped in what’s called the “Medicaid gap.” They cannot get health insurance through because the law prevents people below the poverty line from using the insurance exchanges. So the private insurance alternative is closed to them, even as their states refuse to expand public coverage.
