The annual open enrollment for people who purchase insurance on Healthcare.gov ends December 15, and so far, enrollment is lagging compared to last year.
Sign-ups on Healthcare.gov, the federally-run marketplace that 39 states use, are down 545,929, or 11.7 percent, from last year with three days left to go, according to data released Wednesday by the Department of Health and Human Services (HHS). Notably, the number of new consumers enrolling dropped by 19.7 percent. So far, about 4.1 million people signed up whereas more than 4.6 million people signed up at this point last year.
This estimate doesn’t include data from 11 states and the District of Columbia that run their own exchanges, and six (California, Colorado, Rhode Island, Minnesota, Massachusetts, New York) of these states and D.C. have longer enrollment periods. Nor does this figure include people who automatically renewed their plans, which are tallied at the end.
Even so, there are a lot of reasons why enrollment could be down. The caveat, of course, is that every year there’s a last minute surge, as people usually wait until the final days to sign up. Already, officials say they are seeing an uptick in the volume of people using Healthcare.gov and phoning the call center. Some consumers are even being asked to leave their information with the call center, and are being told that they will be contacted after the deadline to complete their applications; their plans should still kick in January 1.
Having trouble enrolling in a plan on https://t.co/7qbUAqdrC8? If you call 1-800-318-2596 from now until December 15, you can leave your contact information and will be called back to enroll in a plan — even if it's after the December 15 deadline.
— Aisling McDonough (@AislingMcDL) December 12, 2018
Perhaps the most obvious reason fewer people signed up for health coverage so far this year is because they just don’t know open enrollment, which began November 1, is ongoing. According to a Kaiser Family Foundation poll from late November, more than 70 percent of people who purchase their own insurance or are uninsured were unaware of or were misinformed about open enrollment dates.
This is likely due to the fact that the Trump administration slashed outreach by 90 percent. Top HHS official Seema Verma said she was pleased with how many people signed up last year for 2018 plans and, as a result, didn’t think the administration needed to change its approach. Approximately 8.8 million people signed up for 2018 plans on Healthcare.gov. For comparison, nearly 9.2 million signed up for 2017 plans.
But when the administration cut advertising and outreach, Obama-era officials organized their own campaign to get people to sign up. Other grassroots campaigns were launched as well. There was also a lot of press, as the media reported about Republican attempts to sabotage Obamacare and efforts by the GOP-controlled Congress to repeal parts or all of the 2010 health law. One consequence of this was that some people ended up incorrectly assuming that Congress had repealed the law.
By comparison, this year, there’s just isn’t as much coverage about open enrollment. Broadcast news has barely mentioned it, with Fox devoting the most coverage to the issue (just under 14 minutes between October and December). President Donald Trump, with his 56.2 million Twitter followers, hasn’t even tweeted about it. Former President Barack Obama, however, did tweet information about open enrollment to his 104 million followers on Monday, the same day Healthcare.gov experienced the highest traffic this enrollment cycle.
In addition to the Trump administration’s rollbacks to outreach and marketing, open enrollment could also be down because people are purchasing short-term health plans, or skimpy health plans the administration decided to regulate less. The administration is also steering people to websites where people can directly purchase these types of plans. A report released by the Sunlight Foundation Wednesday morning revealed that the Trump administration altered the Healthcare.gov website a few weeks after open enrollment began, removing information about ways to apply (like by phone and mail) and replacing it with a link to external enrollment sites operated by a for-profit software company, “BigWave Systems.”
Tweaked https://t.co/0jFRsXgPXO steers people to agents & brokers, private websites — where they sell short-term plans and other non-compliant policies. Probably not coincidental.https://t.co/9SmhoEx8tU
— Jonathan Cohn (@CitizenCohn) December 12, 2018
Other reasons could be some are opting to purchase Medicaid instead (Virginia just expanded eligibility under the Affordable Care Act). And others simply can’t afford coverage because they don’t qualify for federal subsidies.
NEW analysis: Rather than continuing to go without insurance, *4.2 million* uninsured people could get an #ACA bronze plan for FREE
— Cynthia Cox (@cynthiaccox) December 11, 2018
If people are eligible for premium subsidies, or earn between 100 to 400 percent of the federal poverty level, they could purchase really cheap bronze plans this year. In fact, 4.2 million people without health insurance nationwide could purchase the high-deductible plan for free, according to a recent Kaiser Family Foundation study.
Supporters of the health law are typically the first to say Obamacare isn’t perfect, and Democratic lawmakers are already debating what health policy to prioritize in the new Congress. But there are a few tweaks that can make a notable difference to the marketplace. ThinkProgress spoke to various experts last week, including the New Jersey governor and Colorado’s chief insurance regulator, who mostly recommended that lawmakers properly fund Healthcare.gov outreach and help those who don’t qualify for subsidies. Lawmakers will need to devote more dollars to these fixes, but, as Avalere Health’s Chris Sloan said, “generally the solving will cost money.”