- Aaron P. Bernstein/Reuters
- Sign ups for Obamacare health insurance plans through the Healthcare.gov marketplace fell 4% for 2019.
- While this is the second straight year that enrollment declined, the final tally is much better than earlier numbers suggested.
- The drop was due to a slew of reasons ranging from the repeal of the individual mandate in the GOP tax law to Virginia’s expansion of Medicaid.
Obamacare enrollment declined for the second straight year, but the number of people enrolling in health insurance plans for 2019 remained relatively resilient following a year of uncertainty fueled by President Donald Trump and Republicans in Congress.
Enrollment in Affordable Care Act health plans through the federally-managed Healthcare.gov platform totaled about 8.5 million during this year’s open enrollment period, down 4% from last year, according to preliminary data released Wednesday by the Centers for Medicare and Medicaid Services.
34 of the 39 states that use Healthcare.gov reported enrollment declines compared to the same period in 2017, with just Wyoming, Hawaii, Florida, Mississippi, and Oklahoma showing increases. Others states, such as New York and California, run their own sign-up systems and have different deadlines.
The numbers come as a substantial rebound for enrollment. Previous weekly updates from CMS showed enrollment on track to fall as much as 12% year-over-year. A lot of people usually sign up for health plans right around the deadline, which was December 15.
Matthew Borsch, an analyst at BMO Capital Markets, said the sign-up figures were better than he expected.
“This is good for the ACA exchanges and we think makes it highly likely we will see a stable risk pool next year,” he said.
Larry Levitt, a senior vice president at the health policy think tank The Kaiser Family Foundation, said the numbers prove the continued strength of the Obamacare market despite a slew of changes by the Trump administration.
“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,” Levitt tweeted Wednesday.
These enrollment numbers are preliminary, and last year’s total fell slightly between the end of open enrollment and CMS’s final evaluation.
Obamacare faced a lot of challenges during this sign-up season
There were a slew of challenges facing Obamacare during the sixth open enrollment period, with everything from the elimination of the individual mandate to the expansion of Medicaid in Virginia contributing to the slowdown in sign-ups.
Seema Verma, the chief of CMS, told reporters that the overall sign-up numbers were “steady as compared to previous years” and proved that the Trump administration had stabilized the marketplaces. Verma also pointed to the strong economy as a key reason for the enrollment decline.
“People are now getting jobs and those jobs are providing health insurance, so those individuals may not need to come to the exchange to get health coverage,” Verma said.
In addition to the strong economy, some of the factors that makes the enrollment numbers even more impressive are:
- The elimination of the individual mandate, the financial penalty for not having insurance. The penalty was decreased to $0 as part of the GOP tax law, making it possible for people to decline coverage without facing a financial hit.
- The Trump administration’s drastic cuts to Obamacare’s advertising and outreach budget which fell to $10 million from $100 million during the Obama administration. Verma disputed the notion that the advertising cuts made a difference in enrollment. “We see no correlation between what we’re spending on advertising and effectuated enrollments,” she said.
- The expansion of short-term, limited-duration plans by the Trump administration. The plans offer a cheaper alternative for younger and healthier consumers, but carry increased risk since the plans offer less coverage.
- The expansion of Medicaid in Virginia. The state saw the largest drop in enrollees this year, and Verma said about 100,000 people who previously bought exchange plans were now eligible for Medicaid coverage.
- Uncertainty over the future of the law, likely exacerbated by a judge’s ruling on Friday – the day before the final day of enrollment – that the entire Affordable Care Act (Obamacare’s official name) is unconstitutional.
Add up all of those factors and you’ve got the recipe for the enrollment decrease.
West Virginia saw the biggest decline in enrollment compared to last year.
Rusty Harvilla has been helping people in West Virginia sign up for ACA health plans since 2013. He said he thinks two big changes are responsible for the decline: the end of Obamacare’s requirement that everybody buy insurance, and a big reduction in advertising and enrollment support from the Trump administration.
Harvilla said he often got phone calls from people asking if they still had to buy health insurance this year. He said he’d answer that they didn’t have to buy it, but he’d also tell them it was a good idea to be covered.
“I had that question a lot this time around,” he said. “And I would be honest with them and say no, you don’t have to buy it.”
Harvilla said Obamacare has never been popular.
“It’s toxic,” Harvilla, a certified application counselor at Clay-Battelle Health Services, said by phone. “If they bring it up, we try to steer them toward ACA, the marketplace, those kind of terminologies.”
Still, he said, people are usually grateful for the coverage.
Here’s a breakdown of state-by-state changes in enrollment, compared to enrollment through December 15, 2017, from largest drop to smallest:
- West Virginia -18.74%
- Virginia -17.11%
- Louisiana -16.22%
- Indiana -11.00%
- New Hampshire -10.63%
- New Mexico -10.50%
- Ohio -10.34%
- Missouri -9.35%
- Wisconsin -9.05%
- Delaware -8.86%
- Kansas -8.82%
- Nevada -8.04%
- New Jersey -7.96%
- Iowa -7.79%
- Michigan -7.69%
- Illinois -7.35%
- Pennsylvania -6.75%
- Maine -6.41%
- Oregon -5.75%
- Montana -5.61%
- Kentucky -5.38%
- Georgia -4.71%
- North Dakota -4.54%
- North Carolina -4.11%
- Texas -3.62%
- Arizona -3.43%
- Tennessee -3.11%
- Alaska -2.89%
- South Dakota -2.67%
- Arkansas -1.75%
- Alabama -1.73%
- South Carolina -0.71%
- Nebraska -0.56%
- Utah -0.16%
- Wyoming 0.19%
- Hawaii 1.15%
- Florida 3.20%
- Mississippi 5.56%
- Oklahoma 6.60%