Despite its many challengers, the Affordable Care Act has increased insurance coverage for millions of Americans, reaching an all-time high in opinion polls this year. Now with the 2019 deadline nearing, experts are urging people to sign up despite rising costs.
"There's significant risk in not signing up for coverage," says Miranda Dietz, health policy researcher at the University of California–Berkeley's Labor Center. "I encourage people to check what they're eligible for, whether that's Medicaid or subsidies through [state programs]."
Open enrollment for Affordable Care Act plans and some Medicaid programs ends on Saturday, December 15th. Many states allow people with "qualifying" life events, such as a change of address, to sign up later, but those looking for ACA plans can check their eligibility at HealthCare.gov.
Following the Trump administration's changes to the system, here's what's new about this enrollment period.
Who's Signing Up for Health Insurance—and Who's Not?
Enrollment has been down in the weeks leading up to the deadline, compared to last year—but, as the New York Times reports, this may be because more people are signing up for Medicaid and newly available non-ACA plans. Moreover, this year's deadline has not been widely publicized, since the Trump administration slashed the ACA's marketing budget this summer.
People may also be turned off by the price or process: A recent report predicted that as many as 4.4 million Californians could go uninsured by 2023—some because they aren't aware of their eligibility, others because of rising costs and the repeal of the individual mandate (more on that below).
What Does the Medicaid Expansion Mean for 2019?
As expansions kick in, more people are signing up for Medicaid programs this year, according to the Centers for Medicaid & Medicare Services. Under the ACA, states expanded Medicaid programs to cover millions of low-income adults—although the roll-out has only reached 37 states, according to the non-partisan health-care non-profit Families USA. After a five-year battle in the state legislature, Virginia began enrollment for its expanded Medicaid program; other states passed ballot measures doing the same this year.
What's the Deal With the Individual Mandate?
The individual mandate required people who did not purchase a plan to pay a penalty—a controversial part of law that experts believe helped keep prices down. While the employer mandate still stands, the Trump administration's repeal of the individual mandate could leave 13 million people uninsured, according to 2017 Congressional Budget Office estimates. "We think the penalty going away will certainly have a measurable effect, but we're not heading toward a death spiral," says Dietz, who wrote the report looking at enrollment in California.
Research suggests the act's premium subsidies for private coverage and Medicaid expansion accounted for more of the nationwide coverage increase than the mandate did, but Dietz says it's hard to "tease out" the effect of the penalty alone. "If you go without that extra nudge, some people [will] either drop their coverage or not bother to renew their coverage, and some people, without that extra nudge, won't shop for coverage," Dietz says. The resulting price increases, while minor, will be felt in individual markets and Medicaid programs across the country. In contrast, the more healthy, younger people who sign up for ACA plans, the more affordable the options will be.