ACA enrollment likely to come up short
With one week to go before the Affordable Care Act's fifth open enrollment comes to an end on Dec. 15, experts believe it's highly unlikely HealthCare.gov signups will match last year's.
The number of Americans signing up for coverage each week since open enrollment began Nov. 1 has blown past last year, topping 3.6 million people in the first five weeks, according to the most recent data from the CMS.
But the pace of signups likely wasn't enough to make up for the truncated enrollment period and the cuts in funding for marketing and outreach. The Trump administration slashed the open enrollment period this year to 45 days from 90 days.
That was an idea that originated with the Obama administration. But the Trump administration also gutted the Obamacare outreach budget, reducing the money spent on advertising to $10 million from $100 million. High premium increases that resulted in part from the Trump administration's decision to end the ACA cost-sharing reduction subsidies also deterred customers from shopping for coverage. Many feared they wouldn't be able to afford a plan.
"The pace of enrollment on a weekly basis is up over last year, suggesting that demand for coverage is still high. But with a shorter open enrollment period, the clock is just going to run out," Larry Levitt, senior vice president at the Kaiser Family Foundation, which tracks ACA enrollment, said in an email.
An analysis by consulting firm Avalere showed just how far behind enrollment is tracking this year: On Dec. 2, open enrollment was three-quarters of the way finished with 3.6 million sign-ups. During previous ACA enrollment periods in the past two years, more than 7.2 million people had signed up for coverage when the period was almost 75% complete.
The ACA exchanges have struggled with pulling in enough young, healthy enrollees to balance out the medical costs of sick enrollees. Lower enrollment throws that mix even further off balance, and could lead to even higher premiums next year. The open enrollment period for 2017 coverage ended with 9.2 million people either selecting plans or automatically enrolling through HealthCare.gov, used by 39 states.
Navigators that help people sign up for ACA coverage agree that interest in ACA coverage remains strong.
Shelli Quenga, director of programs for South Carolina navigator group the Palmetto Project, said ACA enrollment in the state has been steady over the last few weeks, and her employees have had full appointment schedules since the start.
"We expect to be swamped next week," she said, anticipating a surge in enrollment as last-minute procrastinators hurry to sign up before the deadline.
This year, existing ACA exchange customers who don't actively enroll in coverage through HealthCare.gov will be automatically enrolled in the same plan or a similar one on Dec. 16. But unlike in previous years, enrollees who don't like their plans won't be able to switch to a new one.
Rick Notter, director for individual business at Blue Cross Blue Shield of Michigan, said enrollment in the insurer's exchange plans appears to be up over last year, but it's hard to tell until customers pay their first-month premiums. Still, while Blue Cross' enrollment may increase, "we think the market might be shrinking a little bit in Michigan as a result of premium increases," he said.
While enrollment ends soon for states that use the federal exchange, many state-based exchanges extended their deadlines. Enrollment ends on Jan. 31 in California, and the state's exchange said this week that more than 102,000 new consumers signed up for coverage during the first month of open enrollment, compared to 80,000 new consumers last year. At the same time, 1.2 million have renewed coverage in the state's exchange, similar to last year. California ramped up its ACA marketing budget to $111 million for this year's open enrollment.
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