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The Impact of Health Reform on Insurance Coverage

Projection scenarios over 10 years


There are many uncertainties regarding the economic, behavioral, political, and strategic events that could help to determine the impact of the Affordable Care Act (ACA) on insurance coverage over the next 10 years. Variables include the cost of ACA, the rate of health care inflation, implementation of the law (e.g., delays, changes in penalty levels), the design and operation of health insurance exchanges, and employer coverage decisions.

Deloitte used its Health Reform Impact Model to evaluate four likely scenarios of ACA’s impact on health insurance coverage and to project enrollment in 2020:

  1. Intended results: Baseline;
  2. Unintended results: Employers drop coverage;
  3. Unintended results: No individual penalty; and
  4. Unintended results: Delays/changes to original legislation.

The scenario results generated numerous considerations for the future, among them:

  • The employer exit from coverage after 2014 and effectiveness of state health insurance exchanges will impact the future of insurance coverage substantially.
  • Each health care sector is impacted by changes in insurance coverage.
  • There is high likelihood of changes to ACA individual/employer penalties:
    • Federal lawmakers might enact legislation to discourage employers from dropping coverage.
    • States might implement substitutes for the individual mandate that would increase enrollment for younger eligibles.

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