The federal government reported that 11.4 million people selected a health plan through the Affordable Care Act exchanges during the most recent open-enrollment period for coverage in 2019—the first year in which there is no penalty for not buying health insurance.
Across all states, enrollment slid by about 300,000 people, or 2.6%, from 2018. That decrease was driven by lower enrollment in the 39 states that use the federally operated marketplace known as HealthCare.gov. Enrollment in the 12 states running their own exchanges ticked up by almost 1%.
"There is a growing divide between states running their own insurance exchanges and those relying on the federal government," said Larry Levitt, a senior vice president at the Kaiser Family Foundation who tracks enrollment in the exchanges. "It's hard to tease out exactly why, but one big difference is that the states have not reduced outreach so significantly like the federal government."
That data released by the CMS on Monday is part of its final comprehensive report detailing ACA exchange enrollment and premiums in all states. It follows a report from January that included data only from HealthCare.gov states.
The trends generally remain the same: Enrollment decreased across most states, though not by as much as some had predicted at the start of open enrollment in November 2018. Enrollment in HealthCare.gov states fell by 3.8% on average to 8.4 million, while enrollment in states operating their own exchanges rose by about 26,000 to a little more than 3 million.