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Editorial
August 2015

Health Policy Update 2015Yet Another Exciting and Turbulent Year Ahead

Author Affiliations
  • 1Project HOPE, Bethesda, Maryland
  • 2University of California San Francisco, Medicine, San Francisco, California
  • 3Editor, JAMA Internal Medicine
JAMA Intern Med. 2015;175(8):1274-1277. doi:10.1001/jamainternmed.2015.3059

This year has already seen a major piece of significant bipartisan legislation1 as well as continued unfolding of many challenges in achieving meaningful health care reform.

Unlike the initial enrollment period of the Affordable Care Act (ACA), the second year’s enrollment functioned smoothly. Also unlike the first year, the enrollment period was 3 months rather than 6 months. As reported in the Washington Post,2 by February 15, 2015, 11.4 million people had enrolled—8.6 million of them in the federal exchange. The numbers for the federal exchange showed a little more than half (52%) enrolling for the first time, with the remainder reenrolling. Enrollment in the federal exchange increased more than in the state exchanges—61% vs 12%. Sylvia Mathews Burwell,3 Secretary of the US Department of Health and Human Services (HHS), had predicted an enrollment of 9.1 million after the second cycle, much less than the 12 million that the Congressional Budget Office predicted for year 2.4 It is hard to know whether this was a deliberate underestimate of the second-year enrollment goal, but it was not a surprise that the 9-million figure was surpassed, especially given the administration’s decision to use autoenrollment. In 2014, 85% of those who enrolled paid their premiums. If this pattern continues, 9.7 million Americans will be insured through the exchanges in 2015.2

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