With the deadline approaching to get health coverage through the Affordable Care Act this year, federal and state officials across the country, including President Obama, are making a final push to get people to sign up.
The deadline to select a health plan is Sunday. Americans who don't have coverage in 2016 face a much larger penalty than in previous years — close to $700 for an adult.
The president and First Lady Michelle Obama have recorded interviews to remind people to enroll. And grassroots groups from Los Angeles to Houston to Miami are working overtime as the third open enrollment period under the law draws to a close.
"If you want coverage, now is the time to do it," said Andy Slavitt, who is helping direct the enrollment push as director of the Medicare and Medicaid programs at the U.S. Department of Health and Human Services.
The Obama administration and state health officials in California and elsewhere are aiming to build on the roughly 9 million people who had coverage through the law's insurance marketplaces last year.
Health and Human Services secretary Sylvia M. Burwell has said the agency is expecting slightly more than 10 million enrollees by the end of 2016.
Thus far, the law, often called Obamacare, has helped more than 17 million previously uninsured Americans get coverage, mostly through the marketplaces and through expansions to state Medicaid programs also made possible by the law. (Some of the people on marketplace plans were previously insured).
The law allows Americans who don't get health benefits at work to shop among plans on state-based marketplaces operated by the federal government or by the states themselves.
Consumers making less than four times the federal poverty level — about $47,000 for a single adult or $97,000 for a family of four — qualify for subsidies. Insurers must provide a basic set of benefits and cannot turn away consumers, even if they are sick.
Those who don't have coverage or qualify for an exemption face fines this year of $695 per adult and $347.50 per child, or 2.5% of family income, whichever is larger.
The administration is under pressure to expand enrollment further this year to sustain the 6-year-old law as the president prepares to leave office in 2017.
Higher enrollment — particularly by younger, healthier consumers — is crucial to keeping premiums in check and preventing the marketplaces from collapsing. Several insurers have warned in recent months that too many of their customers in the first two years were sick, and a number of new carriers were forced to close.
Thus far, sign-ups for 2016 have been relatively strong.
There was a substantial surge of consumers toward the end of December, including large numbers of young enrollees and people who were signing up for coverage for the first time.
As of Friday, more than 11.6 million people had selected a health plan or been automatically re-enrolled either through HealthCare.gov, the federally operated marketplace serving 38 states, or through state-operated marketplaces such as Covered California.
Enrollment in at least 14 states — including Oregon, Nevada, Utah, North Dakota, South Dakota, Nebraska, Iowa, Oklahoma, Louisiana, Alabama, Tennessee, Wisconsin, New Jersey and Maine — was running more than 20% ahead of last year, federal officials said.
And with the deadline approaching, traffic on marketplace websites and call centers was increasing dramatically, with 50% more visitors to HealthCare.gov on Thursday than the week before. Thus far, federal officials have not reported any of the kind of problems that paralyzed the site in previous years.
"The call center and website continue to operate smoothly," said Kevin Counihan, who oversees the marketplaces at the federal health agency.
Federal officials said this week that consumers who are in line Sunday night at HealthCare.gov but have not finished the enrollment process would be allowed to complete the process after the deadline passes. Covered California plans to do the same for California shoppers who have started their applications by midnight Pacific time Sunday night.
Even with outreach efforts underway nationwide, health officials face persistent public ignorance about the insurance marketplaces and the deadline.
A recent nationwide poll by the nonprofit Kaiser Family Foundation found just 15% of the uninsured could correctly identify the enrollment deadline, and most said they had not taken steps to find out if they are eligible for coverage.
The Obama administration continues to contend with attacks from GOP lawmakers and presidential candidates, all of whom pledge to repeal the 2010 law if they win the White House.
"So much of the public dialogue about the Affordable Care Act has been about the politics, rather than about the substantive details of the legislation," said Ron Pollack, executive director of consumer advocacy group Families USA, which has been supporting the national enrollment effort.
"As a result, people tend to know that this is politically contentious, but information about the many helpful provisions of the law often hasn't penetrated."
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