CMS reported that 371,676 people selected plans on Healthcare.gov during the first week of open enrollment for the Affordable Care Act exchanges, which went from Nov. 1 to Saturday.
Nearly 90,000 of those consumers were new to the website, the agency said in its weekly snapshot tracking signups. Data is collected for the 39 states that use the federal site for the exchanges and doesn't contain information from the state-run exchanges like those in California, Massachusetts and New York.
Healthcare.gov's call center received 293,664 inquiries over the first three days and the site saw nearly 1.6 million users.
It's still early in the process, but enrollment will need to pick up significantly over the next month to approach last year's numbers.
Enrollment for the exchanges fell to about 11.8 million people during open enrollment for 2018. That was a 4% drop from the previous year. While state-run exchanges saw a 0.2% increase, enrollment in states with the federal-run exchanges decreased 5.3%. That includes Louisiana, which dropped by 23%, and West Virginia, which fell by almost 20%.
In addition to higher premiums in 2018, another reason for the decrease was the Trump administration cutting the open enrollment period to just six weeks, rather than three months (though some of the state-run exchanges expanded their open enrollment beyond those six weeks). Plus, the administration cut the exchanges' advertising budget and funding for the navigator program that helped people sign up for ACA plans.
There are additional issues that may restrict enrollment for 2019. Congress spiked the individual mandate penalty and the Trump administration is expanding short-term health plans and association health plans (AHPs) in hopes of giving Americans more low-cost options.
Critics of the moves say these efforts could cause millions to either drop coverage or leave regular health insurance for a low-cost, low-protection plan. A report from the Society of Actuaries predicted that between 3% and 10% of those in ACA marketplace plans will leave for AHPs. Avalere predicted AHPs will shift 3.2 million enrollees from the individual and small-group markets to AHPs by 2022.
One positive that might help 2019 enrollment, though, is that for the first time ACA federal exchange premiums for the second-lowest cost silver plans are expected to drop by an average of 1.5%. Declining premiums is one example of payers finding their footing in the marketplace. While previous years saw payers flee the exchanges, insurance companies like Centene, Cigna, Oscar Health, Anthem and Wellmark are expanding their exchange footprints for next year.
CMS said recently that more than 20 payers are entering or reentering the ACA marketplace and 29 payers are expanding their footprint in the exchanges in 2019. Counties with one payer option decreased from 56% in 2018 to 39% in 2019.
That said, there are still pockets of the country with little payer competition in the exchanges. Plus, the patient risk pool might be getting sicker, according to a recent Kaiser Family Foundation issue brief.