Though HealthCare.gov sign-ups during this year's open-enrollment period came up short of last year's total, the near-final tally defied the odds.
More than 8.8 million people enrolled in 2018 coverage through the federally run marketplace before open enrollment ended on Dec. 15, despite a shortened sign-up period and slashed federal funding for advertisements and enrollment assistance.
That's just 400,000 less than the 9.2 million people who signed up during the previous open enrollment, which ran twice as long and was bolstered by a $100 million marketing budget.
The final tally could end up even higher—the number doesn't include plan selections for people who enrolled in the last three hours of open enrollment, or those who left their contact information at the call center due to high volume, the CMS said Thursday. The agency said it will release another HealthCare.gov enrollment snapshot next week, and a final report in March that will include data from state-based exchanges.
Most experts who study ACA enrollment from year to year expected sign-ups to fall far below last year's figures. That's because of the many obstacles confronting ACA customers this year under the Trump administration, which has actively sought to undermine the exchanges.
CMS Administrator Seema Verma announced the final enrollment on Twitter, and thanked her team for making open enrollment "the smoothest experience for consumers to date. We take pride in providing great customer service."
This year, the administration slashed funding for marketing and outreach by 90% to $10 million. Funding for navigators, who help people sign up for plans, was slashed, leading many groups to cut staff and cancel enrollment events.
Additionally, uncertainty over the future of cost-sharing reduction subsidies that lower out-of-pocket costs for ACA members led insurers to hike premiums. Those eligible for premium tax credits were shielded from those higher premiums, however. But many insurers stopped selling coverage on the exchanges because of missing CSR payments and financial losses, reducing plan choices for consumers. At the start of open enrollment, navigators said consumers were confused about whether they'd receive federal financial help. Some were unaware of open enrollment deadlines.
Some of the 8.8 million people who signed up or were automatically enrolled will likely fail to pay their first month premiums. Nearly 2 million people who signed up for 2017 coverage, through HealthCare.gov and state-based exchanges, had dropped off the insurance rolls by March 15.
Moreover, with the individual mandate penalty set to be zeroed out, it's likely that many young, healthy ACA members will drop coverage.
The final HealthCare.gov tally does not include consumers who enrolled through state-based exchanges. And so far, some state-based exchanges, many of which extended their enrollment deadlines past mid-December, have said enrollment is exceeding expectations.
In California, for instance, more than 1.4 million people had signed up for health coverage as of Dec. 15. Of those, 220,000 were new enrollees, about 10% more than last year, Covered California said Wednesday. Covered California's enrollment deadline is Jan. 31.
About 109,000 people have enrolled in Minnesota's exchange, about 12.5% ahead of the previous year's enrollment. The deadline to sign up in Minnesota is Jan. 14.
Health insurer Oscar Health, which expanded its ACA exchange footprint for 2018, said Thursday that it will enroll more than 250,000 members in individual plans for next year, compared with about 100,000 in 2017.
