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President Donald Trump’s administration has already had a massive effect on the Affordable Care Act, the healthcare law better known as Obamacare.
In a press release, the Centers for Medicare and Medicaid Services – which oversees the ACA’s public insurance exchanges – provided its typical biweekly update on the end of Obamacare’s open enrollment period, which ran from November 1 through January 31.
The period, during which people without insurance through an employer or Medicare or Medicaid could sign up for coverage, ended with 9.2 million people signed up for plans through the Healthcare.gov platform, not including state-based exchanges.
What’s most startling, however, is how much the sign-ups slowed after Trump took office.
According to the previous biweekly update from the Obama administration, 8.8 million people had signed up through January 14, meaning roughly 800,000 people were enrolling each week. Based on the updated figures from Trump’s CMS, 200,000 Americans signed up for coverage in each of the final two weeks.
This also means that enrollment fell by 400,000 people from the open enrollment period ending in 2016. For reference, there were 100,000 more people enrolled than in the previous year at the last update.
The slow pace at the end could potentially damage the law’s health. The late sign-up period is critical, as the percentage of young people obtaining coverage usually increases, which helps with balancing risk pools for the exchanges.
In the previous three years of the exchanges, the people who have signed up through the exchanges have been older and sicker than expected. This has led to higher costs for insurers, which then are passed on to consumers.
The Obama administration hoped to get more young people to sign up through outreach, especially as the sign-up period came to a close. Instead, communication about the open enrollment period came to a screeching halt after the Obama administration turned the keys over to Trump and his team. The effect on enrollment is clear.
The Twitter account for the Department of Health and Human Services ceased tweeting about signing up for coverage, and Trump’s team rolled back a significant number of TV ads touting Healthcare.gov.
Obama’s HHS officials also reported a higher number of concerned calls regarding the repeal of the law, and independent enrollment advocates reported a lower-than-average number of appointments for assistance in signing up for a plan.
In addition to showing a serious drop-off in enrollments, the CMS update also signaled a shift in how the government will talk about the ACA.
Typically, the CMS releases have conveyed not only data, but also general support for the law, touting what they portrayed as an increase in plan selections from the previous year and the ability for people to gain access to health coverage easily. For example, previous emails frequently noted the percentage of people who could get covered for less than $75 or $100 a month.
But in the first communication about the sign-ups from the Trump administration, the tone was drastically different. After providing the number of sign-ups for plans on Healthcare.gov, the email pointed to increased premiums associated with many of the exchange-based plans.
“On January 31, 2017, open enrollment for 2017 coverage ended with more than 9.2 million plan selections in states that use the Healthcare.gov eligibility and enrollment platform,” the CMS release said. “Those selections were made from a market that experienced a 25 percent increase over the previous year in the average premium for the benchmark second-lowest cost silver plan as well as a 28 percent decline in the number of issuers participating over the past year.”