November 12, 2014 | Rosemarie Day

Open Enrollment: Election Results and What Really Matters

Screen Shot 2014-11-12 at 11.07.53 AMWith the election results just one week old and the next open enrollment for health insurance exchanges only three days away, I took a look at whether these types of events have affected each other (or can be expected to).  And in the swirl of post-election analysis, I also wanted to be sure that we don’t lose sight of what really matters in the next three months:  getting more people insured.


Yes, in some places.  Specifically, one of the most interesting election results I found was in the “toss-up” races for governor in states that had state-based health insurance exchanges.  There were 13 states with close gubernatorial races, 5 of which had state-based exchanges (Connecticut, Colorado, Maryland, Massachusetts, and Rhode Island).1  Of those 5 states, 3 had well-functioning exchanges (CT, CO and RI) and 2 had failing exchanges (MD and MA).  The results:

  • The states with well-functioning exchanges retained their incumbent governor’s party (Democrat).
  • Those with failed exchanges lost the office from the incumbent governor’s party (both Maryland and Massachusetts flipped from Democrat to Republican governors).

Was this a coincidence?  Probably not.  In at least three of the states, the success (or failure) of the exchange was an election issue.  Connecticut’s Governor Dannel Malloy was able to claim credit for the success in his state.  The would-be successor Democrats in Maryland (Lieutenant Governor Anthony Brown) and Massachusetts (Attorney General Martha Coakley) had to find ways to avoid being tarnished for the failure of their state exchanges.  When the electorate is looking for ways to evaluate whether “government is working,” the state-based exchanges can be a prominent indicator.

Bottom Line:  Exchange implementation mattered, particularly in a close race.


Not really.  Open enrollment begins on November 15th, and the preparations have been in the works for months.  These preparations include making technology improvements, organizing outreach to enrollees, increasing call center staffing, and more.  These preparations won’t be affected by the arrival of some new senators and governors (who don’t take office until January anyway).

That said, one of the biggest effects of an election is the amount of advertising that gets generated, and the potential influence those ads can have:

  • About 14% of the political ads mentioned health reform in some way (mostly negative).
  • As a result, over 60% of voters who were surveyed said they had seen a political ad that referenced the Affordable Care Act (ACA) within the past 30 days.
  • Also, almost half of voters had seen an insurer’s ad about obtaining health insurance.

However, there is a big gap between what voters are aware of, and what the uninsured are aware of.   The most concerning statistic I have seen in the past month is this:  89% of uninsured people are unaware that open enrollment starts in November.  That is a HUGE number of people who need to “get the message,” and it appears that the election ads did not raise much awareness for them.  For this shorter (3 month) open enrollment to be a true success, it’s the uninsured who need to know about it.

The Obama administration is already dampening enrollment expectations for 2015 (from the Congressional Budget Office’s projection of 13 million to approximately 9-10 million). This is a significant reduction in expectations, and reflects their belief that a longer ramp-up period will be needed for the ACA.

Bottom line:  Open enrollment messaging is badly needed right now, particularly for the uninsured.


The election’s impact will be felt more as we move beyond this year’s open enrollment:

  • At the state level:  Even though new governors won’t take office until January, their transition work is already underway.  While they won’t have much influence over this open enrollment period, there are some health reform policy decisions that they are likely to review.  At a minimum, we can expect new governors to take a look at their state’s Medicaid expansion decisions.  We can also expect them to look at the opportunity to apply for a “Wyden waiver” in 2017, which would allow their state to forgo many of the ACA’s requirements if they can demonstrate that they can meet the ACA’s goal of reducing the number of uninsured in a different way.  Finally, if Maryland and Massachusetts fail to re-launch their exchanges again, their new governors (and Congress) are unlikely to give them a third chance.
  • At the federal level:  We can expect Congress to tighten up on ACA spending allocations and to scrutinize the ACA implementation even more (including holding hearings to review spending to date).

1. New York Times, Election 2014: Governor Election Results