First week of HealthCare.gov open enrollment is off to a slow start

Americans are signing up for Affordable Care Act exchange coverage at a rate slower than last year.

About 371,700 people signed up for insurance coverage through HealthCare.gov in the first three days of open enrollment that started Nov. 1, the CMS said Wednesday. That's a rate of about 123,900 per day. Of those sign-ups, roughly three-quarters of enrollees had purchased coverage through the Affordable Care Act exchange last year, while a quarter were new customers.

Last year, 601,500 people enrolled in coverage during the first calendar week of open enrollment that spanned four days—a rate of about 150,400 per day.

Open enrollment in most states lasts until Dec. 15. It is unclear how a combination of lower average premiums and actions by Congress and the federal administration will affect enrollment in the ACA-compliant individual market in 2019.

While average premiums are falling in many states for the first time, and consumers have more options on the exchanges as insurers who pulled out come back to the market, the Trump administration has made alternative insurance coverage widely available in 2019.

Many individuals have the option of enrolling in association health plans or short-term insurance coverage that doesn't have to comply with all of the ACA's consumer protections, making those plans more affordable—although less robust—than some HealthCare.gov options.

Moreover, the Trump administration zeroed-out the individual mandate penalty that compelled certain people to enroll in coverage or face a fine, though some experts have argued the penalty wasn't steep enough to keep many people from forgoing insurance in the first place.

Many insurers raised 2019 exchange premiums to account for the loss of the individual mandate penalty and the availability of short-term plans. According to the Kaiser Family Foundation, premiums next year for ACA silver plans will cost 16% more than they otherwise would have if not for several Trump administration and Congressional actions.

Still, the ACA exchanges have proven resilient over the last several years, even in the face of an administration that would like to see the ACA dead. Nearly 11.8 million people signed up or were automatically enrolled in coverage through the health insurance exchanges for 2018 coverage. The initial enrollment count released by the CMS Wednesday doesn't include sign-ups in state-based exchanges or people who will be automatically enrolled.