Exchange enrollment hits wall as insurers struggle to sign up middle class

States fail to reach remaining uninsured consumers, even if they qualify for subsidies

Although insurers have successfully enrolled low-income individuals in health insurance exchanges throughout the country, they have struggled to sign up people earning higher incomes who may still be eligible for subsidies, according to a new analysis from Avalere Health.

Most of the 11.7 million people who have enrolled in an exchange plan have had incomes below the federal poverty level. In fact, 76 percent of individuals with incomes between 100 percent and 150 percent of the federal poverty level signed up on the exchanges, but just 16 percent of people earning up to 400 percent of the federal poverty level obtained health coverage through th exchanges.

"Exchanges will need to attract higher income consumers to ensure enrollment continues to grow over time," Caroline Pearson, senior vice president at Avalere, said in the analysis. "So far, tax credits do not appear to be enough to entice participation, so greater emphasis on individual mandate penalties may be needed to help increase enrollment among low- and middle-income individuals."

Meanwhile, experts are concerned that exchange enrollment is about to stall or even decrease in states where it used to be strong, reported the New York Times

"I think the concern about running out of momentum is legitimate," Jon Kingsdale, the former executive director of the Massachusetts exchange and now a director at the Wakely Consulting Group, told the Times.

California, for example, enrolled the most consumers in 2014 but only increased sign ups by one percentage point this year despite a huge outreach and education campaign. Plus, New York improved its exchange enrollment by only two percentage points.

"It may just become harder and harder as you look at the remaining uninsured population," James Scullary, a spokesman for Covered California, told the Times. That's because the consumers who obtained coverage during the first year of exchange enrollment were more motivated and easier to sign up than the uninsured population that remains.

To learn more:
- here's the Avalere analysis
- read the New York Times article

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