A new analysis predicts there will be 10.1 million people enrolled in exchange plans by the end of 2016, less than half of the number originally predicted by the Congressional Budget Office in 2010.
The analysis, conducted by Avalere Health, is about on par with the Obama administration, which said in January it expects 10 million enrollees by the end of the year. Avalere is an independent consulting firm.
When the health care law was first passed in 2010, the CBO predicted there would be 21 million exchange enrollees in 2016. It has since lowered its prediction to 13 million, which it announced in January of this year, and then again to 12 million, announced in March.
Avalere named several possible reasons enrollment is lower than predicted, including people retaining their employer or off-exchange individual coverage, low participation from healthy and middle-income people and lack of education about financial assistance.
Exchange enrollees to date tend to be older and lower income compared to the potential exchange population, the analysis found. These groups are often more expensive to cover than younger, wealthier people. Males and Hispanics have enrolled in exchanges at lower rates than expected.
The analysis also found exchange participation rates decline significantly as incomes increase and, subsequently, premium assistance decreases. The less someone makes, the more federal financial assistance they qualify for.
For example, 80 percent of the potential exchange population making less than 150 percent of the federal poverty line have enrolled. However, only 2 percent of people with incomes above 400 percent of the poverty level — the cutoff for receiving financial assistance — have enrolled.