How Many People Will Sign Up for ObamaCare’s Exchanges?


Projections of how many Americans will enroll in the Patient Protection and Affordable Care Act (ObamaCare) insurance exchanges are a moving target. The Supreme Court’s ObamaCare ruling in 2012 and the implementation decisions of individual states have kept federal projections in flux. Initial estimates of 14 million enrollees in 2014 have been quietly downplayed by the Centers for Medicare and Medicaid Services—an agency within the Department of Health and Human Services. The non-partisan Congressional Budget Office now predicts just 7 million people will enroll in the exchanges in 2014. The administration hopes that enrollment will rise to 24 million individuals by 2017.

The Foundation for Government Accountability (FGA) keeps tabs on these federal projections and calculates enrollment projections on a state-by-state basis. Over the next six months, FGA will track actual enrollment as well to see how successful the federal government has been in convincing Americans to enroll in the ObamaCare exchanges.




Enrollment projections produced for the Society of Actuaries with the Lewin Group’s Health Benefits Simulation Model (HBSM) were used to calculate the distribution of exchange enrollees by state. The HBSM projections were modeled for each state with and without the optional Medicaid expansion. States’ current decisions on whether to expand Medicaid were utilized to determine ultimate enrollment in each state. These decisions were reported by the Centers for Medicare and Medicaid Services. Because the HBSM projections assume ultimate enrollment in the exchanges is immediate, the projections were revised downward to reflect the fact that enrollment will likely phase in over the next few years. National projections of exchange enrollment produced by the Congressional Budget Office were used to revise downward the total enrollment figures.

Given that Medicaid expansion discussions are ongoing, these estimates could change from time to time. The Foundation for Government Accountability is actively monitoring this process and will update these projections to reflect future changes.