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A Project of The Annenberg Public Policy Center

Moving the Goalposts

President Barack Obama says the Affordable Care Act is working “a little bit better than we anticipated,” based on the 11.4 million people who signed up for insurance on the exchanges during the recent open enrollment period. That’s better than the administration anticipated, but worse than a Congressional Budget Office projection.

The latest open enrollment period for those buying insurance through the federal HealthCare.gov or the state-based exchanges was from Nov. 15, 2014, through Feb. 15 of this year. In a video on the White House website and posted on Twitter, Health and Human Services Secretary Sylvia Burwell tells Obama that the “preliminary estimates” show 11.4 million people either signed up for or re-enrolled in marketplace plans during that period. Obama says that’s “great news,” telling viewers: “The Affordable Care Act is working. It’s working a little bit better than we anticipated. Certainly, I think working a lot better than many of the critics talked about early on.”

The 11.4 million figure is better than the projection released by the administration in November, just before the enrollment period began. Then, HHS told reporters that it anticipated between 10.3 million and 11.2 million would sign up or re-enroll by the end of the open enrollment period. By that measure, the estimated 11.4 million who did sign up is “a little bit better” than anticipated.

But an HHS analysis said the department expected the figure would decline by the year’s end, as some wouldn’t pay premiums or would take other health insurance. The analysis estimated that between 9 million and 9.9 million would be the total for 2015’s marketplace enrollment. That’s 3 million to 4 million fewer Americans than the nonpartisan Congressional Budget Office’s estimate at the time: 13 million on marketplace, or exchange, plans this year.

So, the 11.4 million figure is a little bit worse than the CBO anticipated. CBO’s 13 million estimate is from April 2014; the most recent report, from January, estimates that 12 million would be on marketplace plans this year.

These estimates are just that: estimates. And the CBO, too, constantly updates its forecasts. In March 2011, CBO estimated 14 million would be on marketplace plans in 2015; the year before that, days before the final legislation was signed into law, it put the number at 13 million.

But the administration’s November analysis moved the goalposts, saying that it would take longer than CBO estimated for marketplace enrollment to grow.

The CBO expects a major expansion of exchange enrollment in the next few years — going from 12 million in 2015 up to 21 million in 2016 and then 25 million for 2017 and subsequent years, according to the most recent CBO report. HHS said in its analysis that enrollment won’t reach 25 million that quickly, due to uncertainty over the number of shifts that may occur from employer-sponsored and individually purchased insurance to the marketplace plans. HHS says the growth CBO expects could happen over four or five years, not three, and that its 9 million estimate for 2015 is actually similar to CBO’s numbers if they were modified to fit that longer period of time.

It’s easier to come out ahead, of course, if expectations are lowered.

The administration did cite CBO’s estimate for marketplace signups in 2014, before the federal and state marketplace websites launched. Then-HHS Secretary Kathleen Sebelius said in a June 2013 press conference that “we’re hopeful that 7 million is a realistic target.” And Marilyn Tavenner, the administrator of the Centers for Medicare & Medicaid Services, gave the 7 million projection in a leaked Sept. 5, 2013, memo. The administration then backed away from that number after the HealthCare.gov website got off to a shaky start and initial enrollment was slow. In late December 2013, White House aide Phil Schiliro told MSNBC, “That was never our target number,” a claim that earned him two Pinocchios from the Washington Post’s Fact Checker.

In the end, 8 million signed up for exchange plans during 2014’s open enrollment, a number that slipped to 7.1 million by October 2014 as some didn’t pay premiums or took other insurance, such as through a new job. That just beat CBO’s estimate. But this year, the administration rejected the CBO estimate rather than embrace it.

The White House also boasts in a graphic on its website: “Thanks to the Affordable Care Act, about 11.4 million Americans are signed up for private health coverage,” adding the hashtag #11MillionAndCounting. The “thanks to the ACA” wording suggests that those Americans wouldn’t have had private insurance otherwise. And that’s not the case.

In fact, as the HHS explains in its analysis, those who enroll in marketplace plans come from three groups: those re-enrolling in marketplace plans, those shifting from other individual insurance or employer plans, and those who were previously uninsured. We don’t know how many moved from a private plan outside the exchanges to a new private plan sold through the exchanges. But CBO estimates that the number with employer-sponsored coverage or insurance purchased individually outside of the marketplaces will decline by 5 million in 2015.

— Lori Robertson