Dive Brief:
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The Government Accountability Office said the Trump administration should review how its efforts have reduced membership to Affordable Care Act exchange plans.
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GAO made three recommendations to improve those numbers, including establish numeric enrollment targets, making sure information for navigator organization awards are accurate and exploring other parts of the consumer experience. CMS agreed with two of the recommendations but rejected the idea of enrollment targets.
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The HHS reduced outreach and advertising efforts for the plans, and also shortened the open enrollment period. GAO said those decisions were partially to blame for 5% fewer people enrolling in the federally-run exchanges in 39 states.
Dive Insight:
Enrollment in those 39 states dropped to 8.7 million people for 2018. That was 5% less than the previous year and 900,000 fewer people than 2016. That trend happened as the states with their own exchanges have seen better or consistent numbers.
GAO said rising premiums were likely partially to blame. However, most people in the exchanges receive tax credits that help reduce premiums. Higher premiums actually kicked in larger tax credits. So, many people were protected from huge premium spikes.
Trump administration efforts and cuts led to the smaller numbers, according to the report. The Trump administration cut advertising efforts by 90%, sliced the open enrollment period in half and reduced funding for navigator organizations by 42%.
HHS also resisted numeric enrollment targets for 2018. Instead, they focused on "enhancing the consumer experiment" during open enrollment. That may have been a mistake, as setting numeric targets would let HHS monitor and evaluate performance, GAO said.
"Further, while HHS reported meeting its goal of enhancing the consumer experience, such as by improving healthcare.gov availability, it did not measure aspects of the consumer experience it had identified as key in 2017, such as successful outreach events. Absent a more complete assessment, HHS may not be able to fully assess its progress toward its goal of enhancing the consumer experience and may miss opportunities to improve other aspects of the consumer experience," the watchdog said.
Despite the White House and Republicans on Capitol Hill taking aim at the exchanges and the ACA, enrollment numbers decreased less than expected for 2018. Next year will be a watershed for the exchanges. The individual mandate penalty goes away, which a recent report said could reverse coverage gains since implementation of the ACA.
Nevertheless, payers are requesting smaller premium increases for 2019, which shows they have figured out a way to maintain stability despite multiple attacks on the exchanges.
Payers like Centene and Oscar Health are continuing ACA plan expansion in 2019. Even Anthem, which pulled back on the exchanges, is looking at possible modest increases next year.
Though payers are looking at some increases, a recent report found that insurance brokers expect fewer young, healthy people in the exchanges in the coming years. Brokers said the Trump administration expanding short-term plans and association health plans will tempt healthier people to lower-cost plans with fewer protections. That movement will result in a sicker and more costly risk pool in the exchanges.