About 8.45 million people signed up for health insurance through the Affordable Care Act federal exchanges by the Saturday deadline, according to CMS. That's down about 367,000 from the prior year, according to Kaiser Family Foundation senior vice president Larry Levitt, but less of a drop that feared. The numbers are preliminary and don't represent the final exchange open enrollment figures.
Though the final tally represents a 4% drop from last year, a final hour surge in enrollment made up some of the deficit moving into the last day — unaffected, or perhaps prompted, by a federal judge's controversial decision to rule the ACA unconstitutional on Friday, the eve of the open enrollment deadline.
The sign-ups don't include enrollment in states with their own exchanges, including California, New York and Massachusetts. Those states, many of which have longer open enrollment periods, will release their totals later.
Enrollment numbers in the federal exchanges were not as low as feared. CMS called the overall enrollment numbers "steady." CMS Administrative Seema Verma trumpeted a marketplace that's more competitive and stable.
Verma said the enrollment decrease could be connected to low unemployment rates. Also, a handful of states are expanding Medicaid next year, including Virginia, which may result in 100,000 ACA plan members switching to Medicaid in January.
Some pundits warned that policy changes coming next year will hurt the ACA marketplace, and Wednesday's figures were definitely influenced by actions taken in Washington.
The Trump administration cut the open enrollment period in half for the past two years, slashed advertising for the ACA exchanges and cut the number of navigators who help consumers find plans. Also, Congress voted to end the individual mandate penalty and the administration is expanding low-cost, short-term plans in 2019. All of those actions will likely result in fewer people in ACA plans.
However, the 2019 numbers show that those changes haven't made a hugely significant dent in the ACA plan population yet. Levitt said on Twitter the enrollment shows the marketplace is "far from dead and remarkably resilient."
With 8.5 million people signed up for health insurance for 2019 in the federal ACA marketplace, it is far from dead and remarkably resilient.— Larry Levitt (@larry_levitt) December 19, 2018
The end of the individual mandate penalty hasn't caused the mass exodus of ACA members some predicted. Chris Sloan, director at Avalere Health, said on Twitter the result shows that the individual mandate "has not been driving enrollment in exchanges in any meaningful way."
Despite all the volatility, premium increases last year, new short term plans, individual mandate going away, premiums going down in some states this year, more participating plans for 2019, and all; enrollment stayed basically flat. This market is hard to shake loose.— Chris Sloan (@chrisavalere) December 19, 2018
President Donald Trump famously said the exchanges were in a "death spiral" last year, but the ACA exchanges have actually stabilized since then as payers found their footing. An example of this stability is that ACA plan average premiums will go down by 1.5% in 2019. It will be the first average decrease since the ACA was implemented.
Verma credits the Trump administration for the decrease, but others say it's connected to payers increasing premiums too much in previous years.
One influence for the lower rates is more payers entering the marketplace in 2019. More than 20 payers are entering or re-entering the ACA exchanges and 29 payers are expanding their footprints in 2019.
The final enrollment number for the federal exchanges will likely increase beyond 8.5 million. CMS said some consumers had to leave their information with a call center now contacting those consumers. Those potential enrollments are not part of the 8.5 million figure CMS released.
And that figure doesn't include states with their own exchanges. Last year, states with their own exchanges saw a higher increase in ACA plan enrollment compared to the previous year than the federal exchanges. Overall, about 11.8 million people signed up for the 2018 coverage year, which was a 4% decrease from the previous year.
For 2018, the 34 states running federal exchanges saw membership drop by 5.3%, while the states with their own exchanges saw a 0.2% increase.