Sylvia Mathews Burwell, HHS chief: Next president should preserve Obamacare’s gains

President Obama’s top health official said Friday the next administration should push for universal coverage by solidifying Obamacare’s gains in taxpayer-subsidized coverage, urging holdout states to expand Medicaid and prodding Congress to revamp U.S. immigration laws.

Health and Human Services Secretary Sylvia Mathews Burwell said that by focusing on those three things, the U.S. would be able to cover a significant portion of the 30 million people who still lack health insurance.

Mrs. Burwell weighed in on the fate of the administration’s health legacy one day after HHS announced the results of Obamacare’s third round of open enrollment.

She said the three-month signup period exceeded her expectations by bringing in 12.7 million people to the law’s web-based exchanges, where customers can buy plans and qualify for government subsidies.

At least 4 million of them were brand-new customers who can “leaven the risk pool” and keep premiums in check, she said, after the sickest customers were quick to snap up affordable coverage in the law’s early rounds.

HHS is already preparing for the 2017 signup period, she said, even if the Obama administration must give way before enrollment ends.

“The last 12 days, basically, we won’t be here,” she said, assuming proposed enrollment dates are finalized.

Beyond the exchanges, officials are leaning on 19 states that have rebuffed the part of Obamacare that would expand Medicaid coverage to people making up to 138 percent of the federal poverty level.

And without changes to immigration laws, the administration says health insurance will remain out of reach for the millions of undocumented residents who have no path to legal status, leaving them with dim prospects for job-based coverage and ineligible for Obamacare or other government health programs.

“We’re continuing, as you can see, with the marketplace, to continue to grow it. Medicaid is the other large population that would make a big difference, and then the third change in terms of things that would contribute to a large number is actual changes in the immigration laws,” Mrs. Burwell said.

The secretary couldn’t say how many illegal immigrants would be eligible for coverage, should Congress decide to act.

However, the nonpartisan Kaiser Family Foundation has estimated that 15 percent of the remaining uninsured, or 4.9 million people, were ineligible for Medicaid or Obamacare’s subsidized health plans because of their immigration status as of the start of 2015.

Republicans in charge of Congress have ruled out immigration reform while Mr. Obama is in office, saying he can’t be trusted on border security, though Mrs. Burwell and her team have 11 months left to negotiate with states that are considering Medicaid expansion.

Mrs. Burwell was bullish on their prospects, saying governors and legislatures who’ve shirked expansion will reconsider as the costs of uncompensated care force more hospitals to close.

“This is a question of ’when,’” she said.

As the nation set its sights beyond Mr. Obama’s tenure, the secretary said popular aspects of his signature law are “baked in” at this point — from guaranteed coverage for people with preexisting medical conditions to letting young adults stay on their plans until age 16 — while the web glitches that nearly doomed the law in 2013 are a thing of the past.

Yet HHS is scrambling to make the law’s marketplace more attractive to insurers who’ve reported financial losses on the exchanges.

Relatively healthy customers aged 18-34 comprised about 28 percent of those who signed up on HealthCare.gov this year — roughly the same share as last year. Those customers are needed to balance out sicker customers who are gaining coverage, since they can no longer be denied.

However, Mrs. Burwell said the share of brand-new customers in the young-adult category rose a bit, from 31 percent last year to 33 percent — prodded in part by a rising penalty for remaining uninsured.

“We need to work hard to make sure that we keep those ’news’ in,” she said. “Because that’s the only way you’ll change the number over time.”

So far the nation’s largest insurer, UnitedHealth Group, is not seeing a return on its investment in the new marketplace and has threatened to withdraw from the exchanges by 2017. Other insurers say they’re seeing losses, too, but plan to stick it out.

Still, Mrs. Burwell said nine out of 10 people who sought 2016 coverage on the marketplace could choose from at least three insurers.

“Do we know we need to do continued work? Yes,” she said. “Are we on that? Yes.”

HHS has said it is scaling back the number of reasons someone could sign up outside of the standard enrollment period. It is a way to clamp down on customers who wait to get sick before they get covered, a dynamic that hurts insurers’ margins.

Mrs. Burwell also stressed that 70 percent of HealthCare.gov’s customers came back and shopped for 2016 — an important factor in making sure people get plans they like and stay in them throughout the year.

Six in 10 customers also met the mid-December deadline to have coverage in place by Jan. 1 — compared to 40 percent last year — which indicates that customers are eager to get covered for the full year, according to Mrs. Burwell.

“We know that the issuers prefer that customers start that coverage Jan. 1,” she said. “Paying premiums for the full year is better than a different approach.”