ACA Enrollment Update


Open enrollment–the time when individuals can sign up for health insurance through the ACA Marketplaces–was schedule to end December 15, but the Trump Administration extended the deadline because of technical problems that kept people from enrolling the day of the deadline. . The Trump Administration again made severe cuts to funding for marketing and outreach programs designed to help people enroll in affordable and comprehensive health insurance. Enrollment has declined the last few years, but perhaps not as sharply as expected.

Enrollment decreased by 4% from 11.8 million enrollees in 2018 to 11.4 million in 2019. In the bar chart above, the dark green portion of each bar corresponds to federal exchange enrollees, while the light green shows the number of people enrolled through a state-based exchange. From 2018-2019, state marketplaces retained all their customers.

Twenty-four percent of enrollees were new to the Federal Exchange, suggesting that the individual market is still attracting new consumers, and the average monthly premium decreased from $153 in 2018 to $143 in 2019. The vast majority of enrollees (87%) received a premium discount from the federal government, lowering the monthly price, despite the Trump Administration’s lack of support for the law.

While the downward trend is worrisome, it’s not as bad as it could be given the variety of efforts by the Trump Administration to undo the ACA. In addition to budget cuts for marketing, the Administration made the penalty for not having consecutive health insurance throughout the year $0, an effective repeal of the “individual mandate,” which was devised to promote the inclusion of healthier Americans (who might skip getting coverage) in the insurance pool. The so-called repeal is also at the center of a legal battle that could invalidate the ACA entirely. Other efforts at undermining the ACA include the marketing and proliferation of health insurance plans that do not comply with ACA requirements (see PHP articles on short-term health plans and association health plans).

In another attempt to confuse the process and lower ACA participation, the December 15 deadline for enrollment was 45 days before the deadline enacted by the Obama Administration. For now, the ACA survives. In many places, it has stabilized, allowing the millions of Americans who obtain insurance to become healthier.

Databyte via “Health Insurance Exchanges 2019 Open Enrollment Report,” Center for Medicare and Medicaid Services. 25 March, 2019.