The number of consumers signing up this fall for health coverage under the Affordable Care Act held almost steady from the year before, even though the government is no longer enforcing the requirement that most Americans have health insurance.
About 8.3 million people chose ACA health plans for 2020 in the 38 states that rely on the federal HealthCare.gov enrollment system, according to federal figures released Friday that reflect a dip of less than 2 percent from a year ago.
The enrollment snapshot shows a marginal increase in newcomers buying insurance through the federal marketplace — now just more than 2 million.
The Trump administration has been trying to dismantle the law yet has vowed to run a smooth enrollment system as long as the statute exists. On Friday, a top administration health official said the enrollment tally shows the insurance exchange is stable.
“Far from undermining the Affordable Care Act — as some hysterical and inaccurate claims would have it — the Trump administration is making the very best of what remains a failed experiment,” said Seema Verma, administrator of the federal Centers for Medicare and Medicaid Services, the agency that oversees the process.
The enrollment snapshot helps answer a question that has hovered over the insurance marketplaces since a Republican Congress adopted tax changes in late 2017 that ended an Internal Revenue Service penalty on Americans who failed to comply with the law’s insurance mandate. This is the first year the penalty is gone.
As the 2010 law was being drafted, health policy experts and Democrats eager to expand insurance coverage had debated how important the requirement was to motivating uninsured Americans to buy plans. The snapshot suggests that removing the risk of penalty has not made much difference.
Still, Dan Mendelson, founder of Avalere Health, a Washington-based consulting firm and an Office of Management and Budget official in the Clinton White House, called the enrollment “anemic.” He noted that the number of Americans who have gained insurance through marketplace plans or an expansion of Medicaid has turned out to be roughly half of the 40 million predicted when the ACA passed nearly a decade ago.
“It’s a market that has failed to come into fruition,” he said.
The new tally is for the seventh year the ACA marketplaces are providing a way for people to buy coverage if they cannot get health benefits through a job, as most Americans do. The figures come from a six-week open enrollment window that began Nov. 1 and ended at midnight Tuesday. The administration has halved the sign-up period, among several anti-ACA steps it has taken, including nearly eliminating federal aid for publicizing enrollment and providing assistance through nonprofit groups.
Under a move to foster a greater role for the private sector, it also allowed consumers for this first time this year to buy ACA health plans directly from insurers, rather than through HealthCare.gov.
Compared with the system’s beginnings in the fall of 2013, when the computer sign-up was so riddled with defects that many people were unable to enroll, this year was relatively snag-free. Still, CMS allowed consumers an extra two days to enroll after some people could not get onto the website on the final, busy day, and others left phone numbers for callbacks.
The tally does not include those who enrolled in the few hours after midnight at the end of the small extension or all of those who asked to receive a callback. Nor does the snapshot make clear how many returning customers actively chose health plans and how many were automatically re-enrolled. People who chose or were assigned to plans must make a first payment for coverage to start in January.
A more complete report, including sign-ups in a dozen states plus Washington, D.C., that operate their own marketplaces, is typically issued in late winter.
Instead of making a dent in middle-class Americans’ access to affordable coverage, Mendelson said, most people with ACA health plans have relatively low incomes that qualify them for the largest federal subsidies the law provides to help offset insurance premiums.
And he added, “you can’t celebrate flat enrollment” in an environment in which more Americans are becoming uninsured. During the first three years of the ACA marketplaces and expanded Medicaid in some states, the ranks of the uninsured dwindled significantly. But it has risen again by a few million people the past two years.