ACA enrollment up, but may not overcome shorter signup period
The Affordable Care Act (ACA) exchange signups are higher than a year ago after 18 days, but are not on pace to reach last year’s numbers
Nearly 2.3 million Americans signed up for ACA plan coverage through Nov. 18: about 200,000 more compared to the first 26 days of open enrollment last year.
- But President Donald Trump’s administration cut the open enrollment period in half from 12 to six weeks this year, which means the weekly average must double to reach last year’s figures. American Enterprise Institute adjunct scholar Chris Conover wrote in Forbes that current enrollment is 158% of last year’s numbers when it actually needs to be at 200% to reach last year’s 12.2 million final numbers.
These figures are only for the 39 states that use the federal healthcare.gov site for the exchanges, including Florida, which leads the way with nearly 500,000 ACA plan signups so far. The CMS’ numbers do not count the enrollments for states with their own exchanges like Massachusetts and California. However, those states are also seeing more open enrollment activity.
The CMS said the third week of open enrollment (Nov. 12-18) saw nearly 800,000 people sign up for an ACA plan, including 220,000 new enrollees. Of the nearly 2.3 million ACA plan enrollees so far for 2018, more than 556,000 of them are new enrollees, which may offset some of the sickest members in the risk pool.
In addition to reducing the open enrollment period this year, the Trump administration cut the ACA’s open enrollment advertising budget by 90% and reduced the budget for the navigator program, which helps people get ACA plans, by 40%.
The lack of advertising and outreach is having an effect. A recent Kaiser Health Tracking Poll found that nearly half of people surveyed said they heard less about open enrollment this year compared to previous years and nearly 40% said they heard about the same this year.
The poll also found:
Three in 10 people surveyed said they have not heard about the ACA’s open enrollment period this year.
Three in 10 say they have heard only “a little.”
Four in 10 said they have heard “some.”
Only 18% of those surveyed said they have heard “a lot” about open enrollment.
That lack of advertising and outreach could play a key factor during the remaining three weeks of open enrollment. Many people typically do not sign up for an ACA plan until just before the deadline. However, if they have not even heard about this year’s open enrollment, how will they know that the deadline is six weeks earlier this year?
They might not realize that they no longer have until the end of January to sign up, so last-minute signups may not occur at the same rate as previous years. That final push is needed if the final ACA plan numbers can approach last year’s results.
Many of those who are signing up for plans this year are finding cheaper premiums. Trump stopped paying cost-sharing reduction (CSR) payments to insurers. The payments help keep down out-of-pocket costs for lower-income people. Though stopping CSR payments took another shot at the ACA, Trump’s move to stop CSR payments actually backfired. Insurance companies raised their premiums higher because of the CSR uncertainty, but a provision in the ACA kicked in to reduce the higher premiums.
Those who qualify for premium tax credits may find cheaper alternatives for 2018 with the government picking up more of the tab on premiums. However, those who make above 400% of the federal poverty level will pay much higher premiums next year.
Legislation on Capitol Hill dubbed the Alexander-Murray bill would maintain CSR payments for two years. The bill could stabilize the market for the time being, but would not offer any long-term solutions to the individual market and exchanges.