Heads Up: Less than 45 days until ACA open enrollment and re-enrollment | Behavioral Healthcare Executive Skip to content Skip to navigation

Heads Up: Less than 45 days until ACA open enrollment and re-enrollment

October 8, 2014
by Ron Manderscheid
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Tempus fugit—time really flies!

On November 15, the state Health Insurance Exchanges will begin the second Affordable Care Act (ACA) open-enrollment period. This period will extend from November 15, 2014, to February 15, 2015. Although health insurance enrollment likely will not receive the same, unrelenting, daily fanfare and scrutiny as last year, we should not make the mistake of thinking that this new enrollment period is any less important for us than last year’s. Also, we must remember that enrollment in the state Medicaid Expansions is continuous throughout the year.

Enrollments during 2013-14

First, let’s recall a few basic statistics. The state Health Insurance Marketplaces are seeking to enroll about 21 million persons. For the 2013-2014 open enrollment period, HHS estimates that about 10.5 million persons actually were enrolled. That means an equal number remain to be enrolled. The state Medicaid Expansions intend to reach a population of about 19 million persons. Thus far, in the 27 states and DC undertaking the Medicaid Expansions, about 8.5 million persons have been enrolled. That means 10.5 million remain to be enrolled.

Informative maps are available from the Enroll America site that show state Health Insurance Marketplace enrollments during the initial open enrollment period.  The maps depict information on the number of individuals who enrolled in Marketplace plans between October 1, 2013, and April 19, 2014, in the 36 states where consumers enrolled through HealthCare.gov. You can access these maps here.

A total of almost 13 million people with a mental or substance use condition, or both, were without health insurance at the beginning of the 2013-2014 open enrollment period.  Optimistically (federal data are not available), we estimate that up to 2.6 million were enrolled through the state Health Insurance Marketplaces this past year, and 3.7 million more through the state Medicaid Expansions. That leaves almost 7 million more to be enrolled this coming year.

We all have a personal responsibility to help these 7 million people become enrolled in health insurance. For some, that will involve our direct work with uninsured individuals and families. For others, it will involve our significant advocacy efforts to demand that the state undertake the Medicaid Expansion. Social justice principles require nothing less of us.

Enrollment will be more difficult in 2014-2015

In addition to being more difficult to reach than those enrolled last year, we also can predict that persons with these conditions will be more difficult to enroll in health insurance, as documented by almost a decade of experience with mandatory insurance in Massachusetts. Thus, it should cause all of us to pause by noting that up to 7 million of the remaining 21 million persons to be enrolled—fully one-third—have a mental or substance use condition.



Ron Manderscheid

Exec. Dir., NACBHDD and NARMH

Ron Manderscheid



Ron Manderscheid, Ph.D., serves as the Executive Director of the National Association of County...

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