ACA exchange sign-ups hold steady

Enrollment in Affordable Care Act exchange coverage for 2020 remains largely stable compared with the current year, preliminary federal data released Friday show.

The CMS said 8.3 million people signed up or were automatically enrolled in a health plan during the HealthCare.gov open enrollment through Dec. 17. That's a dip of 1.8% from roughly 8.5 million sign-ups in open enrollment last year.

CMS Administrator Seema Verma cheered the stability of the exchanges while simultaneously reiterating the Trump administration's claims that the exchanges are failing.

"We are reporting that for the third year in a row enrollment in the federal exchange remained stable. Far from undermining the Affordable Care Act, as some hysterical and inaccurate claims would have it, the Trump administration is making the very best of what remains a failed experiment," she said in a statement.

Total sign-ups in states using HealthCare.gov could be higher than reported. The tally does not include the final three hours of open enrollment, which was extended for an extra 36 hours after HealthCare.gov experienced some glitches on Dec. 15. It also does not include plan selections from people who left their contact information at the call center due to high volume.

The final tally also doesn't include the millions of people who chose a health plan through the 12 other state-run exchanges. A report that folds in those numbers is slated to come out in March, the CMS said.

Part of the decrease in enrollment can be attributed to Nevada's switch to a state-based exchange for 2020. About 84,000 people in Nevada enrolled in a plan last year; this year's count doesn't include sign-ups in the state. Adjusting for that, enrollment was down less than 1% year over year.

Enrollment in the ACA exchanges held steady despite multiple obstacles, including the proliferation of short-term limited-duration health plans allowed under a 2018 federal rule. Those plans sidestep ACA protections for people with pre-existing conditions and don't have to cover essential health benefits.

In recent years, the Trump administration also slashed the open enrollment budget for advertising and in-person assistance, while cutting the sign-up period in half. Pervasive confusion among Americans about the status of the healthcare exchanges amid repeated challenges to the ACA have also likely contributed to decreased enrollment.

Even so, more new customers signed up for a plan this year. The number of new customers who bought a plan increased by about 2%, or 36,900 people, while the number of people renewing their coverage decreased 3%, or about 187,900 people.

"Overcoming these obstacles means the marketplaces are more resilient than ever," Joshua Peck, co-founder of national campaign Get America Covered, wrote in a blog post Friday.

Average premiums for 2020 silver plans on HealthCare.gov decreased about 4% from 2019. Most people who buy coverage on the exchanges receive federal financial assistance, which helps them afford their premiums. Those ineligible for a premium subsidy must shoulder the full monthly cost and high deductibles.

"For all our successes, too many Americans who do not qualify for subsidies still cannot afford premiums that remain in the stratosphere—constituting a new class of uninsured," Verma said. "The Affordable Care Act remains fundamentally broken and nothing less than wholesale reforms can fix it."