HealthCare.gov sign-ups drop 400,000 during open enrollment

A little more than 1.9 million people signed up for health insurance in the first three weeks of the Affordable Care Act open enrollment for 2019 coverage. That compares with almost 2.3 million during the first three weeks of open enrollment last year, which included an additional day.

Americans are signing up for coverage through the federal marketplace at a slower rate this year, but the CMS numbers don't include enrollment in states that operate their own exchanges. It also does not include those who will be automatically enrolled in plans during the last week of open enrollment, which ends Dec. 15 in most states.

Some states with their own insurance exchanges have reported higher sign-ups this year. In Minnesota, nearly 98,000 people enrolled in exchange coverage during the first two weeks of open enrollment, up 6.9% over the first two weeks last year.

And about 25,600 residents selected a plan in the first two weeks of Colorado's open enrollment—13.1% ahead of last year's period.

It is unclear how a combination of lower average premiums and actions by Congress and the Trump administration will affect enrollment in the ACA-compliant individual market in 2019. Average premiums are falling in many states, and consumers have more options on the exchanges as insurers who pulled out come back to the market. Still, premiums are higher than they would be if not for certain administration and congressional actions.

The Trump administration expanded access to alternative insurance coverage, such as association health plans and short-term insurance plans, which is expected to lure some individuals away from the exchanges. These alternative plans can sidestep some of the ACA's consumer protections, making those plans more affordable—although less robust—than some HealthCare.gov options.

The administration has also slashed funding for navigators who help people enroll in ACA coverage, while Congress zeroed out the individual mandate penalty for not having insurance starting in 2019.

Experts have also pointed out that Medicaid expansion is taking effect in Virginia, which could dampen enrollment in the exchanges as more residents take up Medicaid coverage. Still, they note the exchanges have proven resilient in the past. And in previous years, enrollment figures are boosted by a surge of last-minute sign-ups.