With the Deadline Fast Approaching, ACA Open Enrollment Numbers Look Grim

Since the sign-up period began on November 1st, slightly more than 4.1 million people have enrolled in 2019 plans—a significant decline in comparison with previous years.
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The Trump administration and the Republican Party have taken numerous steps to undermine the ACA's non-group market.

The Trump administration and the Republican Party have taken numerous steps to undermine the ACA's non-group market.

With a Saturday deadline to sign up for 2019 health insurance plans through the Affordable Care Act's HealthCare.gov marketplace, health-care experts worry enrollment is on track to fall dramatically this year.

According to a recent enrollment update from the Centers for Medicare and Medicaid Services, between December 2nd and December 8th (which is the sixth week of this year's open enrollment period), 934,269 people selected health insurance plans for 2019 on the platform. All in, since the sign-up period began on November 1st, slightly more than 4.1 million people have enrolled in 2019 plans. This represents a significant decline in comparison with previous years, which has prompted alarm among some health-care experts.

"4.1 million people have signed up for ACA coverage through the federal marketplace, down 11.7 percent from last year," tweeted Larry Levitt, the senior vice president at the Kaiser Family Foundation. "Most significantly, the number of new consumers enrolling is down 19.7 percent. The deadline is December 15. This is not looking good."

(Some experts have cautioned against reaching firm conclusions until the final enrollment numbers, including those from states that run their own marketplaces, are tallied.)

The trend follows a year in which the Trump administration and the Republican Party have taken numerous steps to undermine the ACA's non-group market—repealing the individual mandate (as part of the 2017 tax cuts), cutting funding for outreach and enrollment assistance, and issuing orders permitting states to allow the sale of short-term plans. More positively, as Reed Abelson and Margaret Sanger-Katz pointed out in a recent article in the New York Times, the trend occurred in a year in which unemployment continued to fall (which may mean that more people have employer-sponsored insurance), and Virginia expanded Medicaid.

Interestingly, the trend is also occurring at a time when subsidized consumers in some states can score very inexpensive bronze-level insurance plans, thanks to the manner in which many states responded to the Trump administration's decision last year to cancel the cost-sharing reduction payments.

In fact, in a KFF analysis released earlier this year, Levitt and a team of researchers estimate that about 4.2 million currently uninsured Americans "are eligible to purchase a bronze plan with $0 premiums after subsidies in 2019." This includes over 600,000 Florida residents, almost 300,000 North Carolina residents, and over one million Texans. The researchers also point out that low-income Americans will be able to purchase benchmark silver-level plans—which have lower out-of-pocket costs than bronze-level plans—for about $20 to $130 per month (after premium subsidies).

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