WASHINGTON — In a surprisingly pessimistic forecast, the Obama administration predicted Thursday that only one million additional people would be covered at the end of 2016 by health insurance purchased through the Affordable Care Act’s new public marketplaces.  After an elaborate analysis of demographic data, Sylvia Mathews Burwell, the secretary of health and human services, said that 10 million people were expected to have marketplace coverage at the end of next year. She called that “a strong and realistic goal.” That is millions short of earlier projections.  “We still have work to do to bring access to affordable, quality health insurance to all Americans,” Ms. Burwell said. “But we’re getting closer to that goal.”  About 9.9 million people had coverage through the federal and state insurance exchanges at the end of June, and administration officials predict that the enrollment will decline to 9.1 million by the end of this year. Some people fall off the rolls because they fail to pay their share of premiums. Others may obtain employer-sponsored coverage through a new job.  The next open enrollment period for the insurance marketplaces begins Nov. 1 and continues to Jan. 31.  Because of gains in coverage in the last two years, Ms. Burwell said, there are fewer uninsured Americans, and “they are a little harder to reach.”  In addition, she said, “the remaining uninsured have a lot of concerns about whether they can afford coverage,” even with the financial assistance available under the Affordable Care Act.  The Congressional Budget Office had predicted in March that enrollment through the exchanges would reach 11 million this year and 21 million in 2016.  But administration officials said that estimate was based on assumptions that proved to be invalid. For example, they said, the budget office assumed that significant numbers of employers would drop coverage and send their workers into the insurance exchanges, but that has not happened.  Discussing plans for the coming enrollment campaign, Ms. Burwell said, “Our target assumes that more than one out of every four of the eligible uninsured will select plans.”  The new enrollment goal could serve a political purpose for Democrats running for election in 2016. They can more easily defend the Affordable Care Act if they can show it is achieving a goal set by the government. For their part, Republicans seize on any evidence of difficulties to buttress their claim that the law has been an expensive failure.  Census Bureau reports, considered the most authoritative source of data, show that nearly nine million people gained health insurance last year, lowering the ranks of the uninsured to 10.4 percent of the population, down from 13.3 percent in 2013. The change reflected the expansion of Medicaid in many states, as well as the purchase of subsidized insurance through the exchanges.  Obama administration officials said their efforts to expand coverage this fall would focus on five areas with large numbers of uninsured people: Dallas, Houston, northern New Jersey, Chicago and Miami.  Ms. Burwell laid out a series of intricate calculations to arrive at the goal of having 10 million people enrolled through the exchanges at the end of 2016.  She estimates that 7.3 million to 8.8 million people who now have marketplace coverage will select plans or be automatically re-enrolled in 2016. She estimates that 2.8 million to 3.9 million uninsured people will select plans in the coming enrollment period. And she predicts that 900,000 to 1.5 million people who bought insurance outside the exchanges this year will switch to policies sold through the marketplaces in 2016.  Combining these projections, Ms. Burwell estimates that 11 million to 14.1 million people will select health plans from November through January. Of these, she said, 9.4 million to 11.4 million will pay their premiums and retain marketplace coverage next year.  “I believe in clear metrics and goals,” Ms. Burwell said. “So 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 one million more than this year.”
The number of Americans covered through exchanges is expected to grow by only one million by the end of 2016, for a total of 10 million, a much smaller number than earlier projections.