Obamacare enrollment is winding down. How successful was Trump’s sabotage?

It's been a tumultuous open enrollment. Here's why.

President Donald Trump pauses during a ceremony in the East Room of the White House in Washington, July 31, 2017. (CREDIT: AP Photo/Pablo Martinez Monsivais)
President Donald Trump pauses during a ceremony in the East Room of the White House in Washington, July 31, 2017. (CREDIT: AP Photo/Pablo Martinez Monsivais)

People who don’t have health insurance through work have two more days to sign up for coverage if they purchase plans on HealthCare.gov. The deadline is December 15 at 11:59 p.m. for all residents, except for those in nine states and Washington, D.C., who have longer sign-up periods. People in areas impacted by hurricanes received deadline extensions, but if they want coverage by January 1, they must sign up by December 15.

About 4.7 million people have signed up for coverage so far, according to the Centers for Medicare and Medicaid Services (CMS). Over a million people signed up for coverage last week, and 388,984 were new customers. For comparison, during this time last year, Obamacare saw only 331,994 new sign-ups.

This is good news, say consumer advocates.

Experts and advocates are eyeing another surge in last minute sign-ups, thanks to procrastinators, and auto-enrollment for people who didn’t actively enroll but have 2017 plans that automatically renew. This could mean a significant increase in sign-ups by December 15th, but enrollment may still fall short compared to past years’ because enrollment is shorter. While the numbers released on Wednesday are something to smile about, it’s hard to be certain 2018 numbers will be comparable or outpace previous open enrollment numbers:

Credit: Avalere
Credit: Avalere

Educated guesses on how many people will sign up by the deadline range between 7.5 million to 8.9 million. For context, 9.2 million people signed up for 2017 health plans. (These enrollment figures don’t account for state exchanges or off-market sign-ups.) That means about 300,000 people will likely be left without health insurance in the coming year.

The Obama administration decided to shorten open enrollment initially, but as the Trump administration carried out this decision, it simultaneously undermined the marketplace in other ways. And this is why more people could be without health insurance in 2018.

There are several policy decisions at play here. The Obamacare marketplace is riddled with problem spots that make coverage less alluring: plans are sometimes more expensive than paying the tax penalty; most plans have restrictive networks; and there are limited insurer options in rural areas of the country. That said, President Donald Trump and his team deliberately tried to make coverage harder and open enrollment unnecessarily tumultuous.

Here’s why this open enrollment period was so jittery:

Insurers were not paid for subsidizing low-income people’s health plans

Two weeks before enrollment, Trump stopped reimbursing insurance companies for providing cost sharing reductions (CSR), a discount that lowers deductibles, co-pays, and coinsurance. His decision to finally end these payments — a move he threatened to make for months — prompted uncertainty and stress, but accidentally resulted in free health plans:

CREDIT: Avalere
CREDIT: Avalere

This year’s cheap premium plans are thanks to clever planning by state officials and insurance companies, who transferred CSR losses onto another subsidy that the federal government had to pay for: premium tax credits. This meant cheaper premium plans for enrollees who qualify for federal help — meaning the Trump administration paid for the damage they created. While this was good news for the majority of consumers who qualify for tax credits, it was bad news for people who make above 400 percent of the federal poverty level (or $81,680 for a family of three in 2017) and don’t qualify. These people saw significant price hikes.

Cut ad budget by 90 percent

Free health plans could attract people to the marketplace, but the federal government did not advertise this at all. In fact, not only did the Trump administration scale back the advertisement budget, officials barely advertised open enrollment by word of mouth — which is free. There were a couple of tweets from agency accounts. But the president, the man with the largest bully pulpit, was largely mute on Obamacare open enrollment, unless he was badmouthing it.

While the Trump administration took a backseat, other organizations — with significantly less money and manpower — looked to fill the void. Groups like Get Covered and the Indivisble ACA Signup Project formed. President Barack Obama, former Centers for Medicare and Medicaid Services officials Andy Slavitt and Lori Lodes, and even late night host Jimmy Kimmel plugged HealthCare.gov.

Cut budget for organizations that help people sign up

Health care is confusing, and the administration significantly reduced the budget for groups that help make sense of it.

The federal government is only paying navigators for the number of Obamacare sign-ups, but navigators also help people sign up for Medicaid or the Children’s Health Insurance Program (the latter of which is still waiting for funding from Congress). They’ve also had to advertise themselves because the federal government opted out.

Three navigator groups from three different states that spoke to ThinkProgress said they’ve tried to make due. “Our biggest challenge has been confusion for consumers and that definitely will be reflected nationwide in the numbers,” said Tia Whitaker, director of outreach and enrollment at the Pennsylvania Association of Community Health Centers, the state’s largest navigator grantee

Another concern is website glitches as last minute sign-ups overload the website. Navigators for Latino HealthCare Forum in Texas said people were able to sign up, but the website is still running slow in the mornings. Kaiser Health News has also reported other glitches that may mean people face application delays.

 


Ultimately, the current health law is surviving this open enrollment period — even as Senate Republicans attempt to repeal provisions of the law as people shop for coverage. But two policy decisions continue to worry consumer advocates looking ahead to 2018: Trump’s October executive order, which federal agencies are still working to implement, and the Republican tax bill. Both would further hobble the marketplace. Then, states and advocates will have to continue to find creative ways to cover consumers.

Correction: This piece originally stated that 11 states have longer sign up periods due to their own state-run exchanges. Two of these states (Idaho and Vermont) still have a deadline of December 15. The deadline for those in hurricane-affected ares has also been clarified.